Controversies about the treatment of myasthenia gravis.

Rowland, Lewis P.

doi:10.1136/jnnp.43.7.644

Cited by 105 publications

(39 citation statements)

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“…Any randomized controlled study in which patients with myasthenia gravis are randomly allocated to surgery, medical therapy alone, or combined therapy has not been performed (Rowland 1980(Rowland , 1987. Therefore an opinion can be hardly expressed on relative effectiveness of the therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Group 4 consisted of those patients who had undergone thymectomy and been prescribed prednisolone. The severity of the disease was rated according to modified Ossermann's classification of 6 categories (Rowland 1980). The evaluations are shown in Table 1 (Oosterhuis et al 1983).…”

Section: Methodsmentioning

confidence: 99%

“…Later the beneficial effect of prednisolone (100 mg on alternate days) was reported (Warmolts et al 1970). The efficacies of prednisolone and other immunosuppressive agents have been also shown (Seybold and Drachman 1974;Rowland 1980). Thymectomy, first used in 1939, has been modified extensively, and extended total thymectomy is currently recommended (Blalock et al 1939;Masaoka and Monden 1981;Spath et al 1987).…”

mentioning

confidence: 99%

“…The benefits of these therapies, in particular, of thymectomy and alternate-day prednisolone treatment, have been well documented and provide a rational approach to the management of most MG patients. Controversy, however, exists (Rowland 1980).…”

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confidence: 99%

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Treatment of Myasthenia Gravis: A Comparison of the Natural Course and Current Therapies.

Seto

Motomura

Takeo

et al. 1993

Tohoku J. Exp. Med.

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Ninety-five patients with generalized myasthenia gravis were followed for 10 years to evaluate the long term effects of prednisolone, thymectomy, or both, and they were compared with a group only with anticholinesterase treatment. Only 15.0% of the patients with anticholinesterase alone had showed improvement 10 years after the onset, but more than 60% of those treated with prednisolone, thymectomy, or both showed improvement. Especially thymectomy induced complete remissions at 10 years after surgery in more than 20 % of the patients. There was no difference between the histology of the thymi and clinical severity, or anti-acetylcholine receptor (AChR) antibody titer. In patients who showed improvement classified "good" of higher 10 years after thymectomy with or without prednisolone, anti-AChR antibody titers swiftly decreased to 37.8% of the value before surgery, and remained low thereafter. This result suggests that the marked decrease in anti-AChR antibody titers within 1 month after thymectomy is a favorable prognostic sign in myasthenia gravis patients who have undergone thymectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Treatment of Myasthenia Gravis: A Comparison of the Natural Course and Current Therapies.

Seto

Motomura

Takeo

et al. 1993

Tohoku J. Exp. Med.

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“…Almost half of patients in our study sample underwent thymectomy. Rowland stated that thymectomy was a standard therapy in all the world, with no contestation of efficacy 27 . However, to date, there have been no prospective, randomized studies to assess the effectiveness of thymectomy for non-thymomatous MG patients.…”

Section: Treatment Proceduresmentioning

confidence: 99%

Myasthenia gravis in Ceará, Brazil: clinical and epidemiological aspects

Aguiar

Carvalho

Costa

et al. 2010

Arq. Neuro-Psiquiatr.

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A retrospective chart review was performed on patients diagnosed as having myasthenia gravis in Ceará State, Brazil and who were followed from October 1981 to June 2009. Clinical and epidemiologic aspects were evaluated. In this work, 122 patients were studied, of whom 85 (69.7%) were females and 37 (30.3%) were males. The disease duration ranged from five months to 50 years (8.9±8.1 years). Age at the first symptoms varied from 0 to 74 years (31.9±14.4 years). The first main symptoms and signs were ptosis, diplopia and limb weakness. Generalized myasthenia was the most common clinical presentation, but 5.1% (n=6) persisted as ocular myasthenia. Thymectomy was performed in 42.6% (n=52) of myasthenic patients. A thymoma was present in 10 patients. Serum acetylcholine receptor (AChR) antibodies were present in 80% (n=20) of specimens tested. The data presented are similar to those of studies performed in other countries. Key words: myasthenia gravis, clinical evaluation, epidemiology.Miastenia gravis no Ceará, Brasil: aspectos clínicos e epidemiológicos RESUMO Foram analisados, retrospectivamente, os prontuários de pacientes miastênicos, diagnosticados e seguidos entre outubro de 1981 e junho de 2009 no Estado do Ceará, Brasil. Foram coletados dados clínicos e epidemiológicos. Na casuística foram estudados 122 pacientes: 85 (69,7%) do sexo feminino e 37 (30,3%) do sexo masculino. O tempo de doença variou de 5 meses a 50 anos (8,9±8,1 anos). A idade de inicio da doença variou de 0 a 74 anos (31,9±14,4 anos). Na amostra estudada, os primeiros sintomas foram principalmente ptose, diplopia e fraqueza dos membros. A maioria dos pacientes apresentou a forma generalizada, enquanto 5,1% (n= 6) persistiram com miastenia ocular. Timectomia foi realizada em 42,6% (n=52) dos pacientes. Timoma estava presente em 10 pacientes. Anticorpo anti-receptor de acetilcolina foi positivo em 80% (n=20) das amostras testadas. Os aspectos clínicos e epidemiológicos da amostra estudada têm semelhança com aqueles estudados em outros países.

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