Tratamento conservador e timectomia na miastenia grave: resultados avaliados a curto e longo prazos

Abstract

A retrospective survey of the records of 33 patients with generalized acquired myasthenia gravis treated at Hospital das Clínicas, Medical School of The University of São Paulo, Brazil and in private practice, with and without thymectomy, is reported. Nineteen were thymectomized and 14 non operated. Both groups were demographically homogeneous and were followed from 8 to 24 years. Parameters for evaluating the natural history of disease and other ones for a comparative analysis of the improvement or remissions were established. The influence of the individualized therapy was evaluated by McNemar test (chi 2); the U-Mann-Whitney was used for evaluation of the populational behavior groups; variable parameter with possible influence in the useful life were studied by multivariate analysis. The difference of distance between both groups was not significant: (D2 = 0.08894); T2 = 7.17 (Hottelling test). There were differences of the isolate clinic parameter response in both groups, but the global analysis of the parameters did not permit to discriminate them, possibly because of interaction of the parameters influencing the analytic result. Inspite of the fact that superposition of the parameter occurred when analysed for a long period, we believe the early thymectomy to be beneficial. Our patients who had their operation at a younger age and specially those with recent disease had a maximum improvement.

Thymectomy in nonthymomatous myasthenia gravis - systematic review and meta-analysis

“…Remission occurred in 181 patients (23%) of the surgical group and in 146 patients (14%) of the non-surgical group. Assis et al [ 30 ], conducted a retrospective study at a single center in Brazil with follow-up of 8 to 24 years. Nineteen patients underwent thymectomy and 14 received medical treatment.…”

“…Assis et al [ 30 ], conducted a retrospective study at a single center in Brazil with follow-up of 8 to 24 years. Nineteen patients underwent thymectomy and 14 received medical treatment.…”

“…The improvement analysis could be conducted only in 13 studies [ 18 – 22 , 24 , 26 – 28 , 30 , 32 – 34 ], including 3063 patients, but due to the high heterogeneity between the studies (87%) in this outcome, it was not appropriate to conduct the meta-analysis (Fig. 3 ).…”

Miastenia grave tratamento clínico x cirúrgico

“…Como critério fundamental para inclusão no estudo, os pacientes deveriam ter tempo de doença acima de um ano, diagnóstico pelo quadro clínico, resposta a anticolinesterásicos, testes eletrofisiológicos e farmacológicos compatíveis, bem como planigrafia de mediastino anterior normal. Foram excluídos os casos de: forma puramente ocular (5), MG congênita (3), formas timomatosas (2), timeetomizados com menos de um ano de duração da doença (4) e tratamento conservador com menos de um ano de seguimento (3). Somente preencheram esses critérios os 65 casos que participaram do estudo.…”

“…considerada benéfica pela quase totalidade dos autores 3,11,15,17,32,37,38,47. Existem diversas tentativas de comparar o valor do tratamento cirúrgico (timectomia) e conservador (medicamentoso)3,7,n,i3,i5,i8,28,38,46 maSj em sua maioria, não são estudos randomizados, prospectivos e bem controlados 7,35. Os corticosteróides são largamente utilizados no tratamento da MG, sendo considerados tanto para formas oculares com limitação funcional e refratarias a anticolinesterásicos 8,35 como para todas as formas incapacitantes 35,39,41.…”