Treatment of Myasthenia Gravis includes medical therapies; anticholinesterase agents, immunosuppressive drugs, plasmaphoresis and gammagloubulin, also surgical therapy of a thymectomy. Medical therapies produce a remission rate low as 15%, surgical therapies high as 80%. We will show that early thymectomy relative to the onset of symptoms results in remission or improvement of symtoms of Myasthenia Gravis.
A 10-year retrospective review (1993-2002) of all thymectomies in myasthenic patients performed at one institution was undertaken.
28 patients reviewed (13 male/15 female), ages ranged from 5 to 74 (mean age of 39). Follow-up was 3 months to 6 years (3 patients lost to follow-up). 11 patients had their thymus removed within 5 months of the onset of symptoms, 10 of 11 (91%) had complete remission or improvement of symptoms. Those whose thymus was removed within 1 year of the onset of symptoms 15 of 19 (79%) had remission or improvement. Those whole thymus was removed within 6 years, 19 of 25 had remission or improvement. The mortality rate was 0 and the complication rate was 35% with complications that included respiratory and cardiac problems, infections, and DVTs. While all patients underwent a median sternotomy, 2 patients had their thymectomies with a CABG and one patient was a redo. 5 of the 28 (18%) had thymomas.Patient Status Time 0-5 months 12 months 6 yearsNo symptoms 8 4 (12) 4 (16)Improvement 2 1 (3) 0 (3)Same 1 1 (2) 1 (3)Worse 0 2 (2) 1 (3)Total 11 7 (19) 6 (25).
Promptness of surgery relative to the onset of symptoms clearly shows a favorable outcome of thymectomy in myasthenia gravis. 91% of patients had improvement or complete resolution of symptoms if their thymus was removed within 5 months of the onset of symptoms. The benefit of a thymectomy is seen even for longstanding myasthenics. Performing a thymectomy early as possible will greatly increase the chances for complete remission of this disease.
Complete thymectomy means better improvement in symptoms.
Jennifer Knight, None.