Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy

Abstract

A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC—especially preoperative anxiety—before performing a thymectomy in patients with MG.

A Review of Psychiatric Comorbidity in Myasthenia Gravis

“…While plasmapheresis reduced weakness and alleviated physical disability; it had no significant impact on diminishing mood disorders or improving mental HRQoL, suggesting that depression and anxiety may represent emotional responses to the progression of MG associated physical disabilities in the chronic course, that remain intractable throughout the early stage of the physical recovery process [26]. Consistent with this, the retrospective CONSORT study of 541 MG cases in China found a statistically significant, independent association between postoperative myasthenic crises following thymectomies and preoperative anxiety by multivariate linear regression analysis (OR = 2.40; 95% CI: 1.33-4.34; p = 0.004) [27].…”

“…Lack of social support, poor coping mechanisms and acceptance of disease, older age of onset, lower education, occupations associated with increased physical labor, career changes associated with MG, and worsening disease severity are independently statistically significant for associations with diminished HRQoL, which, in turn, can induce emotional stress in individuals afflicted with MG [ 14 , 15 , 27 , 34 - 37 ]. In a cyclical fashion, emotional turmoil can further trigger myasthenic exacerbations, resulting in debilitating physical symptoms [ 15 , 38 ].…”

Assessment of the risks of a myasthenic crisis after thymectomy in patients with myasthenia gravis: a systematic review and meta-analysis of 25 studies

“…The results of the heterogeneity test showed evidence of heterogeneity between studies (I 2 = 67%, P = 0.0006). According to the preoperative Osserman stages, the patients were divided into three subgroups: IIa + IIb + III + VI, IIb + III + VI, and VI + V. The results of the heterogeneity test did not reveal any heterogeneity (I 2 = 0, P > 0.1); therefore, the Preoperative dosage of pyridostigmine bromide Five studies [20,22,28,29,35] including 1103 patients provided data on the relationship between the preoperative pyridostigmine bromide dosage and MCAT. The results of the heterogeneity test showed evidence of heterogeneity between studies (I 2 = 92%, P < 0.00001).…”

“…Postoperative risk factors (Fig. 2c) Postoperative lung infection Five studies [8,20,22,33,34] including a total of 989 patients reported the relationship between postoperative lung infection and MCAT. The results of the heterogeneity test showed no evidence of heterogeneity between the studies (I 2 = 0%, P = 0.45); therefore, the fixed effect model was used for the analysis.…”

“…The results of the heterogeneity test showed no evidence of heterogeneity between the studies (I 2 = 0%, P = 0.45); therefore, the fixed effect model was used for the analysis. A postoperative lung infection was an independent risk factor for MCAT [ Thymoma Five studies [20,21,28,29,32] provided data on the relationship between thymoma and MCAT, including 1390 patients. The results of the heterogeneity test showed evidence of heterogeneity between studies (I 2 = 79%, P = 0.0008).…”