Thymectomy for Nonthymomatous Myasthenia Gravis

Bagheri, Reza; Boonstani, Reza; Sadrizadeh, Ali; Salehi, Maryam; Afghani, Reza; Rahnama, Ali; Azmounfar, Vahab; Hakimian, Saeed; Firoozabadi, Mohammad Baradaran

doi:10.1177/155698451801300201

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Complete removal of all thymic tissue is important to obtain the full effect of thymectomy. There seems to be a similar outcome with the minimally invasive techniques and transsternal thymectomy [64–66]. Minimally invasive techniques are preferred with fewer perioperative complications, shorter hospitalization time, and minimal scars.…”

Section: Resultsmentioning

confidence: 99%

Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment

Gilhus,

Andersen,

Andersen

et al. 2024

Euro J of Neurology

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BackgroundGeneralized myasthenia gravis (MG) with antibodies against the acetylcholine receptor is a chronic disease causing muscle weakness. Access to novel treatments warrants authoritative treatment recommendations. The Nordic countries have similar, comprehensive health systems, mandatory health registers, and extensive MG research.MethodsMG experts and patient representatives from the five Nordic countries formed a working group to prepare treatment guidance for MG based on a systematic literature search and consensus meetings.ResultsPyridostigmine represents the first‐line symptomatic treatment, while ambenonium and beta adrenergic agonists are second‐line options. Early thymectomy should be undertaken if a thymoma, and in non‐thymoma patients up to the age of 50–65 years if not obtaining remission on symptomatic treatment. Most patients need immunosuppressive drug treatment. Combining corticosteroids at the lowest possible dose with azathioprine is recommended, rituximab being an alternative first‐line option. Mycophenolate, methotrexate, and tacrolimus represent second‐line immunosuppression. Plasma exchange and intravenous immunoglobulin are used for myasthenic crises and acute exacerbations. Novel complement inhibitors and FcRn blockers are effective and fast‐acting treatments with promising safety profiles. Their use depends on local availability, refunding policies, and cost–benefit analyses. Adapted physical training is recommended. Planning of pregnancies with optimal treatment, information, and awareness of neonatal MG is necessary. Social support and adaptation of work and daily life activities are recommended.ConclusionsSuccessful treatment of MG rests on timely combination of different interventions. Due to spontaneous disease fluctuations, comorbidities, and changes in life conditions, regular long‐term specialized follow‐up is needed. Most patients do reasonably well but there is room for further improvement. Novel treatments are promising, though subject to restricted access due to costs.

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Section: Resultsmentioning

confidence: 99%