Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis: A 17-year experience

Soleimani, Ali Asghar; Moayyeri, Alireza; Akhondzadeh, Shahin; Sadatsafavi, Mohsen; Shalmani, Hamidreza Tavakoli; Soltanzadeh, Akbar

doi:10.1186/1471-2377-4-12

Cited by 38 publications

(27 citation statements)

References 21 publications

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“…57 One retrospective study found that myasthenic patients who had undergone thymectomy had fewer incidences of myasthenic crisis and less-severe episodes. 58 A multicenter, single-blind, randomized controlled trial is currently investigating the benefit of thymectomy in non-thymomatous MG. 59 Postoperative myasthenic crisis is common after thymectomy; the incidence ranges from 12% to 34%. 60,61 Postoperative crisis in these patients has been related to a history of myasthenic crisis, preoperative presence of bulbar weakness, preoperative serum AChR antibody levels >100 nmol/L, and intraoperative blood loss of >1 L. 61 …”

Section: Thymectomymentioning

confidence: 99%

Myasthenic Crisis

Wendell

Levine²

2011

The Neurohospitalist

184

193

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Myasthenic crisis is a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. Advances in critical care have improved the mortality rate associated with myasthenic crisis. This article reviews the epidemiology of myasthenic crisis and discusses patient evaluation. Therapeutic options including mechanical ventilation and pharmacological and surgical treatments are also discussed.

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Section: Thymectomymentioning

confidence: 99%

Myasthenic Crisis

Wendell

Levine²

2011

The Neurohospitalist

184

193

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“…The association of MG with thymic pathology is well known. MC is almost as twice more frequent in patients with thymoma 2,7,14,[23][24][25] . Pregnancy aggravates MG in 33% of the cases, and MC in pregnancy carries high perinatal mortality 2,7,26 .…”

Section: How We Defined Myasthenic Crisis?mentioning

confidence: 99%

“…Type and technique of surgery may affect the occurrence of MC after thymectomy [58][59][60] . The presence of thymoma is the more important isolated postoperative factor to develop MC together with radiation therapy, delayed ventilator weaning, and upper or lower pulmonary tract infections [23][24][25]57 . The risk of MC has decreased with less invasive surgical tecniques such as cervicotomy, partial sternotomy, or video-assisted thoracoscopic 57,59,60 .…”

Section: Immunotherapymentioning

confidence: 99%

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

Godoy

Mello

Masotti³

et al. 2013

Arq. Neuro-Psiquiatr.

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Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC) is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20-30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%.Key words: myasthenic crisis, myasthenia gravis, respiratory failure, immunosupressive therapy, thymectomy. ReSUMOMiastenia grave (MG) é um distúbio autoimune que afeta principalmente a transmissão neuromuscular, levando a fraqueza muscular generalizada ou localizada. É devida mais frequentemente à presença de auto-anticorpos anti-receptores de acetilcolina na fenda pós-sináptica da placa motora. A crise miastênica (CM) é uma complicação da MG caracterizada por piora da fraqueza muscular, resultando en falência respiratória, o que requer entubação endotraqueal e ventilação mecânica.Isto ocorre também em pacientes pós-cirúrgicos, em que há piora da fraqueza muscular devido à MG, causando um atraso na extubação. MC é uma emergência neurológica importante, séria e reversível que afeta 20-30% dos pacientes miastênicos, usualmente duranteo primeiro ano de enfermidade, podendo a crise miastênica ser a manifestação inicial da MG. A maioria dos pacientes tem fatores predisponentes que desencadeiam a crise, geralmente uma infecção do trato respiratório. Imunoglobulina, plasmaférese e esteróides são a pedra angular da imunoterapia. Hoje, dentro da terapia neurocrítica, a taxa de mortalidade na CM é menor que 5%.

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“…46 In a retrospective Iranian series of 229 myasthenic clinic patients, there were more patients who had a crisis and those crises were more severe among those patients who did not have a thymectomy compared with those who did. 47 In a review of thymectomy series over 40 years of 8490 myasthenic patients, those who underwent thymectomy were more likely to have clinical improvement, become asymptomatic, or even attain remission. 48 Thymectomy may be less effective in the elderly due to atrophy of the thymus, so many experts do not recommend surgery to patients older than age 60 years.…”

Section: Myasthenia Gravis: Treatment Optionsmentioning

confidence: 98%