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Thymectomy and anti‐muscle autoantibodies in late‐onset myasthenia gravis
Author(s) -
Romi F.,
Gilhus N. E.,
Varhaug J. E.,
Myking A.,
Skeie G. O.,
Aarli J. A.
Publication year - 2002
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1046/j.1468-1331.2002.00352.x
Subject(s) - thymectomy , myasthenia gravis , medicine , thymoma , titin , antibody , acetylcholine receptor , autoantibody , ryanodine receptor , gastroenterology , immunology , receptor , myocyte , sarcomere
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.