Myesthenia Gravis

Posted by Dr. Raghavan Dr. Raghavan
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A 32 year old female patient came to see me a fortnight ago with complaints of diplopia of 10 days duration. She had gone to an ophthalmologist in her city and was  prescribed glasses with prisms to counter the double vision.This was the history given to me before I saw her.
But it was a spotter when she walked into my clinic at ASH. One look it was MG,myasthenia. I did put her on tablet pyridostgamin 60 mg twice a day since she was quite symptomatic and her ptosis was gross. She was here just for a day and I asked her to see a neurologist in her city immediately on getting back which she did.She was investigated, serum anticholinesterase antibody test,CT  for thymoma and EMG studies. The first two were negative. She has been continued on pyridostigamine.Her diplopia and ptosis have improved considerably but continues to use the prism glasses.She has been in constant touch with me.
Now it appears that her myasthenia both systemic and ocular, possibly ocular was not the first presentation, going by the symptoms she had had the preceding 6 months and most of which had abated after the start of treatment.
Now the questions are
1 Does she undergo thymectomy immediately since she is only 32
2 Her diplopia has not gone as yet. Whether she should also be put on steroids or should that be thought of after thymectomy
3 Any other points to look at.

2 Comments

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Dr. Thamburaj Dr. Thamburaj
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Re: Myesthenia Gravis

Negative pre op studies do not rule out a thymoma.
Thymectomy in nonthymomatous autoimmune myasthenia gravis, is an option to increase the probability of remission or improvement, although the response is highly variable; the chance of benefiting from thymectomy increases in early MG with a sort history.

I suggest thymectomy. Steroids may be employed if thymectomy is not contemplated.

Hope this comment is of help.
Dr Riaz Dr Riaz
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Re: Myesthenia Gravis

In reply to this post by Dr. Raghavan
well said! there were controversial reports of benefits of thymectomy in non-immune MG but in a good surgical set up with good-handed enthusiastic surgeon, avilable in her center, undergoing thymectomy is not a big deal. Pyridostigmine has to be the cornerstone atleast 5 times a day with immunomodulators and the dose and response depends upon the clinical outcome on her ADL. Nevertheless, one can not achieve 100% response in all these modalities and she needs to be on constant supervision for the drugs doses and severity of disease _ taking care not to go into crisis.