The thymus gland in elderly patients with myasthenia gravis

Perlo, Vincent P.; Arnason, Barry; Castleman, Benjamin

doi:10.1212/wnl.25.3.294

Cited by 52 publications

(21 citation statements)

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“…Our results are comparable to those found in earlier studies [5, 26, 27, 28, 29, 30, 31]. In our opinion, the age at MG onset is a more important factor than the age at thymectomy [7, 23, 32].…”

Section: Discussionsupporting

confidence: 91%

“…While the concentration of AChR antibodies is highest in early-onset MG [7], the occurrence of titin and RyR antibodies is highest in late-onset MG [23, 33, 34]and is accompanied by a more severe disease in late-onset MG [22, 23, 35, 36]. Histologically, thymic hyperplasia is seen in thymuses from early-onset MG patients, while thymuses from late-onset MG patients are atrophic [28, 37, 38, 39]. There is a correlation between thymic hyperplasia and DR3, while the presence of titin antibodies in nonthymoma MG patients has been reported to correlate with DR7 [40, 41].…”

Section: Discussionmentioning

confidence: 99%

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Thymectomy in Nonthymoma Early-Onset Myasthenia gravis in Correlation with Disease Severity and Muscle Autoantibodies

Romi

Gilhus

Varhaug³

et al. 2003

Eur Neurol

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Objective: To study the clinical effect of thymectomy in a well-defined early-onset MG subgroup and to correlate it to MG severity, the presence of circulating muscle autoantibodies, and the need for pharmacological treatment in a long-term setting. Methods: Fifty-two consecutive AChR antibody-positive early-onset MG patients (34 thymectomized and 18 nonthymectomized) were included. Severity was assessed and the pharmacological treatment monitored on a yearly basis, starting from the year of MG onset, for 5, 10, 15, and 20 consecutive years; AChR, titin, and RyR antibodies were assayed. Results: In the four follow-up groups, MG severity was significantly higher in nonthymectomized compared to thymectomized MG patients. The postthymectomy MG improvement was significant and persistent. There were 21/34 remissions in thymectomized patients and only 4/18 in the nonthymectomized group. Patients with initially high or low AChR antibody concentration had a similar thymectomy outcome. Only 6 patients had titin antibodies, and none had RyR antibodies. Conclusion: The present study indicates a benefit of thymectomy in early-onset MG. The muscle autoantibody concentration does not influence the outcome of thymectomy in early-onset MG.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Thymectomy in Nonthymoma Early-Onset Myasthenia gravis in Correlation with Disease Severity and Muscle Autoantibodies

Romi

Gilhus

Varhaug³

et al. 2003

Eur Neurol

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“…O índice de remissão entre os nossos pacientes de 48% é comparável aos índices relatados na literatura que variam de 8,3% a 54% 3,13,16,18,19,20,22 .…”

Section: Comentáriosunclassified

“…Não indicamos timectomia para miastênicos sem timoma com mais de 50 anos porque o timo nos idosos não contém tecido tímico ou apresenta involução acentuada 20 . Todavia, vários autores 2,7,15,23 não acham que idade seja contraindicação para timectomia.…”

Section: Comentáriosunclassified

Miastenia gravis: resultados de timectomia em 52 pacientes

Oliveira

Campos

Cardoso

1995

Arq. Neuro-Psiquiatr.

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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 .

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“…Such follicles are infrequent in normal adults but do occur in some patients with SLE or thyrotoxicosis. Perlo et al [145] suggested that hyperplasia does not occur in the elderly MG patient but others [117] report its occurrence. Thymomas occur in 10-157o of MG patients [22,101].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Immunopathology of acetylcholine receptors in myasthenia gravis

Seybold

Lindstrom

1982

Springer Semin Immunopathol

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It is now clear that the muscular weakness and fatigability seen in MG result from an antibody-mediated immune response to AChR. The mechanisms by which antibodies impair transmission are moderately well understood and detection of antibodies in patient's sera is a reliable diagnostic test for the disease. The spectrum of antibody specificities produced in MG is also beginning to be understood, largely through the use of antibodies produced in the experimental model EAMG. Treatment for MG continues to rely heavily on the symptomatic relief afforded by acetylcholinesterase inhibitors. However, the recent recognition of the autoimmune nature of MG has led to increased emphasis on immunosuppression and antibody removal with some beneficial effects. Despite all that has been learned, the level of ignorance has just been pushed back one step--from the neuromuscular junction to the immune system. What initiates the immune response to AChR in MG and how to specifically suppress this aberrant response remain completely unknown.

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The thymus gland in elderly patients with myasthenia gravis

Cited by 52 publications

References 0 publications

Thymectomy in Nonthymoma Early-Onset Myasthenia gravis in Correlation with Disease Severity and Muscle Autoantibodies

Thymectomy in Nonthymoma Early-Onset Myasthenia gravis in Correlation with Disease Severity and Muscle Autoantibodies

Miastenia gravis: resultados de timectomia em 52 pacientes

Immunopathology of acetylcholine receptors in myasthenia gravis

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