Thymectomy and anti-muscle autoantibodies in late-onset myasthenia gravis |
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Authors: | F. Romi,N. E. Gilhus,J. E. Varhaug,A. Myking,G. O. Skeie,& J. A. Aarli |
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Affiliation: | Department of Neurology, Haukeland University Hospital, Bergen, Norway. fredrik.romi@haukeland.no |
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Abstract: | Thymectomy is still widely carried out in myasthenia gravis (MG) patients, but its role, especially in late-onset MG patients, is not established. These patients are immunologically heterogeneous, some with thymoma-like and others with early onset-like features. We evaluated whether any therapeutic effects of thymectomy correlate with the presence of non-acetylcholine receptor (AChR) muscle antibodies. The severity of MG, and titin and ryanodine receptor (RyR) antibodies, were assessed yearly starting from MG onset in 21 thymectomized and 22 non-thymectomized AChR antibody positive late-onset MG patients, who were followed for 2, 3 and 5 years. Clinical or pharmacological remission were seen in six of 11 titin antibody negative but none of the 10 titin antibody positive thymectomized patients, however, the non-thymectomized cases showed an opposite trend. The three MG-related deaths were all in patients with titin antibodies. There was no significant difference in MG severity between thymectomized and non-thymectomized patients; 2 years after MG onset, both groups were significantly improved. This study showed no dramatic benefit from thymectomy in late-onset MG in general. Any limited improvement appeared less likely in cases with titin and/or RyR antibodies. |
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Keywords: | late-onset myasthenia gravis ryanodine receptor antibodies thymectomy titin antibodies |
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