Lu sur http://journal.frontiersin.org/article/ ... 6/abstract cette étude rétrospective de 6 ans réalisée aux Philippines sur des patients MG avec thymectomies comparés à des patents MG non opérés
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Clinical Profile and Outcome of Post-Thymectomy versus Non-Thymectomy Myasthenia Gravis Patients in the Philippine General Hospital: A Six-year Retrospective Study
Ranhel C. De Roxas1*, Artemio Roxas1, Marjorie Anne Bagnas1 and Jonathan Rivera2
1Department of Neurosciences, Philippine General Hospital, Philippines
2Department of Laboratories, Philippine General Hospital, Philippines
Myasthenia gravis is an autoimmune neuromuscular disorder characterized by
the production of abnormal autoantibodies directed against the receptors present in the
neuromuscular junction. It has been the standard practice to offer thymectomy in all
generalized myasthenia gravis patients despite the lack of robust evidence.
The objectives of this study are to describe the clinical profile and differentiate
the clinical outcomes of thymectomy versus non-thymectomy, and thymomatous versus nonthymomatous
myasthenia gravis patients in the Philippine General Hospital.
Between 2009 and 2014, a total of 69 post-thymectomy and 16 nonthymectomy
patient records were successfully retrieved. The demographic characteristics,
surgical approach and histopathologic results were obtained. The clinical outcome after six
months or one year follow-up was also determined and grouped according to the following:
1) complete remission, 2) pharmacological remission, 3) no clinical change 4) worsening
symptoms and 5) mortality.
Majority of patients were females (68.0%) with a mean age of 39.8 years and a
mean duration of myasthenic symptoms of 21 months. Using the MGFA classification,
54.1% of patients fell under Class II and 48.2% of them presented with generalized
weakness. In this study, 60.8% of post-thymectomy myasthenia gravis patients had either
complete remission or pharmacologic remission compared to 12.5% among non-thymectomy
patients (p-value <0.001). No significant difference in the clinical outcome was found
between thymomatous and non-thymomatous myasthenia gravis after thymectomy (p-value
This study showed that both thymomatous and non-thymomatous myasthenia
gravis patients who underwent thymectomy had a higher incidence of complete stable
remission and pharmacologic remission as compared to myasthenia gravis patients who did
not undergo thymectomy.