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Myasthenia Gravis
Published in Charles Theisler, Adjuvant Medical Care, 2023
The hallmark of myasthenia gravis is fluctuating muscle weakness that worsens after periods of activity and improves after periods of rest.1 It most commonly affects young adult women under 40 and men over 60. However, it can occur at any age, including during childhood.1 The disorder is painless. Some cases of myasthenia gravis may go into remission, either temporarily or permanently, and muscle weakness may disappear completely so that medications can be discontinued. Thymectomy is one of the main medical treatment methods for myasthenia gravis. Stable, long-lasting remissions are the goal of treatment.1
Thymectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
There are a number of different surgical approaches to thymectomy and the decision of which one to use depends on the disease process and surgeon preference. However, with perhaps the exception of a giant anterior mediastinal mass, a thoracoscopic approach is generally the most preferable in terms of overall surgical exposure of the gland and the significantly decreased morbidity for the patient. Other approaches include a full median sternotomy, a partial sternal split, or a transverse cervical incision. The anatomy of the thymus often plays a role in surgeon bias when contemplating the surgical approach, especially in cases of MG where a complete resection of all thymic tissue is required.
Neuromuscular Junction Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Qin Li Jiang
An elective thymectomy is also recommended to patients of 18–65 years of age who have generalized MG with AChR-positive antibodies without thymoma. The beneficial effects of thymectomy have been shown to extend for at least 5 years.12,13
Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker’s diverticulum
Published in Baylor University Medical Center Proceedings, 2023
Daniel Tran, Lucas Fair, Bryana Baginski, Bola Aladegbami, Steven Leeds, Marc Ward
The mainstay of treatment for MG in symptomatic patients involves the use of cholinesterase enzyme inhibitors, such as pyridostigmine. If patients remain significantly symptomatic on pyridostigmine, they can be placed on immunosuppressive agents. These typically include glucocorticoids initially, and patients may require immunotherapeutic agents such as azathioprine or mycophenolate.10 Although used for treatment, steroids can lead to exacerbation of MG. Predictors of exacerbation from steroids include older age and bulbar symptoms. Numerous medications, including magnesium, may also exacerbate MG and should be used cautiously in these patients after surgery.5 Lastly, all patients with known MG should have a CT scan of the chest to look for thymomas. Thymectomy has been shown to lead to symptomatic improvement in these patients.11
Quantitative evaluation of drug efficacy in the treatment of myasthenia gravis
Published in Expert Opinion on Investigational Drugs, 2021
Rui Chen, Ningyuan Zhang, Lili Gao, Ying Zhong, Ling Xu, Hongxia Liu, Qingshan Zheng, Lujin Li
A systematic review of population-based epidemiological studies revealed that the incidence of MG was higher in women under 30 years of age and in men over 60 years of age [33]. In addition, clinical outcomes are usually related to their baseline levels, the more serious the baseline level is, the more obvious the improvement of clinical outcome is. However, we did not find that the relative efficacy of QMGs and MG-ADLs were related to age, the percentage of male patients and the basline level, which may be a result of the narrow range of patients enrolled in this study (Supplementary Table S1). However, this study found that the placebo effect of MG-ADLs was positively correlated with the previous TT% within the range of 28.4% to 58.4%. A previous study has reported that the long-term benefits can be obtained with patients after thymectomy [34]. The result suggests that the proportion of patients undergoing thymectomy should be considered in the design of clinical trials, and also be corrected when conducting comparisons across studies.
Clinical manifestations and long-term prognosis of Good syndrome: Results from a single-center cohort study from China
Published in Modern Rheumatology, 2021
Yueting Li, Zhuoran Yao, Mengdi Jiang, Yuxue Nie, Ruxuan Chen, Naixin Liang, Huaxia Yang, Xuan Zhang, Fengchun Zhang
Among the 24 patients who met the criteria of GS, eight (33.3%) were men and 16 (66.7%) were women, with a median disease duration of 56 (IQR 38–93) months. The median ages at diagnosis of GS were 58 years (range 52–62). Fourteen patients (58.3%) went to the clinic with incidentally detected thymoma on computed tomography, while the rest had initial symptoms including fever (7, 29.2%), cough (7, 29.2%), myasthenia (4, 16.7%), diarrhea (2, 8.3%), and rash (2, 8.3%). Twenty-three patients (95.8%) underwent thymectomy. Type AB (10/23, 43.5%) was the most frequent histological type, followed by type A (4/23, 17.4%), type B1 (1/23, 4.3%), and type C (1/23, 4.3%). Twelve patients (50.0%) had symptoms related to autoimmune disorders and 23 (95.8%) patients had infections (Table 1).