Miastenia gravis: resultados de timectomia em 52 pacientes

Abstract

PALAVRAS-CHAVE : miastenia gravis, timectomia Myasthenia gravis: results of thymectomy in 52 patientsSUMMARY -From 1971 to 1993, 52 myasthenics without thymomas ( 7 men and 45 women) were thymectomized.The results were categorized in remissions and non-remissions. The remission rate was 48%. In the remission group there were 5 men and 20 women and in the non-remission group 2 men and 25 women.The follow-up time was 5.5 years in both groups. There were 16 patients in Osserman category II A , 11 achieving remission; 36 patients were in categories IIB and III, and 14 achieved remission. The duration of disease was 1.8 years and 4.3 years in the remission and non-remission groups, respectively. All patients with remission had less than four years of disease but among the 43 patients with less than four years of symptoms, 42% did not achieve remission. Our data reinforce the need for early thymectomy in myasthenia gravis. KEY WORDS: myasthenia gravis, thymectomyA miastenia gravis (MG) é doença neurológica rara, com incidência de 4,4/1.000.000 25 e prevalência entre 50 a 125 casos por um milhão de habitantes 5,25 . Um neurologista, em média, verá um caso a cada três anos !fi , de modo que somente em centros especializados há oportunidade de se ver um número elevado de casos. A doença é caracterizada por fraqueza muscular flutuante que pode acometer a musculatura ocular, bulbar ou sistêmica. De acordo com Oosterhuis 17 , a história natural da MG , sem outro tratamento que anticolinesterásicos, apresenta uma remissão de 20% e uma mortalidade de 25%. As várias formas de terapia, como timectomia, imunossupressão, assistência respiratória e controle de infecções, afetaram sensivelmente a história natural da MG. Assim , no presente, a mortalidade é praticamente zero e a grande maioria dos pacientes tem vida normal 5 .

Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30] Ocular symptoms were the first symptoms described by most MG patients; however, they were not considered the main problem with the disease progression. Bulbar symptoms were considered the most disabling, which is in agreement with some studies.…”

“…In contrast, even recent Brazilian case series 18,19,22,23,25,27,29 used the clinical classification of Osserman-Gerkins, while the recommended standards of clinical research on MG and the international literature have adopted MGFA since the early 2000s. 21,30 conclusion Despite the clinical heterogeneity of MG, the clinical and demographic profiles and therapeutic strategies reported in Brazilian case series are quite similar.…”

“…Conversely, a few Brazilian case series have been reported, describing clinical and sociodemographic features of patients followed at specialized clinics. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] The aim of the current study was to determine the clinical profile of patients with MG under treatment at the Neuromuscular Diseases Clinic of the University Hospital, Federal University of Minas Gerais (UFMG), com-paring it with other series to draw a picture of the MG in Brazil.…”