Forty-eight patients with purely ocular myasthenia were studied. Tensilon test was positive in 46 patients (95%); decremental response from limb muscles was present in 24 patients (50%); anti-AChR antibodies were detected in 20 patients of 44 (45.5%). Twenty-two patients underwent thymectomy, 18 were given corticosteroids, 42 received AChE drugs. At the end of the observation period, 8% of the patients were in remission, 67% were improved, 25% were unchanged. In our experience, the diagnosis of ocular myasthenia relies mainly on clinical data; AChE drugs are not very effective in extrinsic ocular muscles; indications for thymectomy should be restricted to thymoma cases and, perhaps, to patients in the early stages of the disease, within the first year of onset; corticosteroids are effective in most cases, but relapses after withdrawal are not uncommon.
We performed ten plasma perfusion (PP) treatments on eight patients affected by Myasthenia Gravis (MG) with high serum levels of autoantibodies against acetylcholine receptors (anti AChR-AB), and one PP treatment on a patient with MG of probable genetic origin and without specific antibodies. All patients (Osserman group III-IV) had undergone thymectomy and immunosuppressive therapy. Each patient received a treatment cycle of six PP sessions. Clinical conditions were assessed before and after the treatment with evaluation of muscular strength, ventilatory function, and electromyographic testing. Immunologic markers were tested before and after each PP. The patient without specific antibodies showed no improvement with PP and was excluded from our study. All the other patients showed continued improvement, with increased muscle strength and improved respiratory function. Four patients (follow-up 16-24 months) still maintain the clinical improvement; two, unexpectedly relapsed 11-12 months after PP, received a new treatment successfully (follow-up 9-10 month).
The antiacetylcholine receptor antibody was titered in the serum of 63 patients with myasthenia gravis (MG) and 20 control healthy subjects. The titer was significantly high in 92% of MG patients in contrast with none of the controls and no correlation was found with the thymus pathology and the severity of the disease. The titer decreased after thymectomy almost steadily with the improvement of the myasthenic signs. The role of the antibody in the pathogenesis of the disease is discussed.
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