Myasthenia Gravis: Clinical Aspects and Prognosis Following Thymectomy - in Aspect of Bangladesh

Abstract

Background: Medical treatment for myasthenia gravis (MG) involves the use of anticholinesterase agents, immunosuppressive drugs, plasmapheresis, and gamma globulin. However, these agents result in a complete clinical remission rate as low. As a consequence, thymectomy, preferably by transsternal approach, has become increasingly accepted as an efficacious procedure for MG, with reported complete clinical remission rates as high. 

Objective: To assess the clinical aspects of myasthenia gravis and prognosis following Thymectomy.  Methods: This prospective study was carried out on patients diagnosed as Myasthenia Gravis was evaluated by detailed history and examination who admitted in the above Department during the period from May 2013 to April 2015. Total number of patients was 16 and they were divided into two groups: Group A and Group B. Group A considered patients without plasmapheresis or immunoglobulin therapy (n=10) and Group B considered patients with plasmapheresis and/or immunoglobulin therapy (n=6). Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Unpaired t-test, fisher's exact test, Chi-Square test with used to analyse the categorical variables, shown with cross tabulation. P values 1 year and 66.7% in group B. Diurnal variation was found 9(90.0%) in group A and 6(100.0%) in group B. In group A majority 9(90.0%) patients had ptosis and in group B, 6(100.0%) had proximal weakness of limb muscle. Regarding osserman grade, majority 7(70.0%) were grade II a in group A and 6(100.0%) were grade II b in group B. Moderate improvement was observed in 7(77.8%) patients in group A and 4(80.0%) in group B.  Conclusion: Extended thymectomy might be an effective and safe procedure for the treatment of myasthenia gravis. As per study findings, moderate improvement was observed in most of the patients treated with thymectomy.