Summary
The case histories are presented of five patients with long-diagnosed myasthenia gravis (up to 15 years) who underwent splenectomy. A precondition for the decision to operate was muscle weakness that could not be controlled with standard therapy (e.g. anticholinesterase drugs, immunosuppressive measures). After splenectomy, a considerable improvement took place in three cases; in one case there was moderate improvement, and in another, no improvement. The alleviation of myasthenia gravis may be attributable to the reduction of either the number of immunocompetent lymphocytes in an important storage organ or of the total bulk of the immune system in an immune disease with raised autoantibody production. The acetylcholine receptor antibody titre was not affected by the operation in a consistent way. After splenectomy, immunosuppressive medication was tolerated better with respect to its haematological side-effects.
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References
Andersen V, Cohn J, Sörensen SF (1976) Immunological studies in children before and after splenectomy. Acta Paediatr Scand 65:409–415
Cantor H, Boyse EA (1977) Lymphocytes as models for the study of mammalian cell differentiation. Immunol Rev 33:105–124
Dostal G (1977) Der Einfluß des Splenektomiezeitpunktes auf die Überlebensverängerung nach Nierentransplantation bei der Ratte. Langenbecks Arch Chir [Suppl]:250–253
Drachman DB (1978) Myasthenia gravis (first of two parts). N Engl J Med 298:136–142
Drachman DB (1978) Myasthenia gravis (second of two parts). N Engl J Med 298:186–193
Engel WK, Lichter AS, Dalakas MC (1981) Splenic and total body irradiation treatment of Myasthenia gravis. In: Grob D (ed) Myasthenia gravis. Ann NY Acad Sci 377:744–754
Fambrough DM, Drachman DB, Satyanurti S (1973) Neuromuscular junction in Myasthenia gravis: decreased acetylcholine receptors. Science 182:293–295
Hertel G, Mertens HG, Ricker K, Reuther P (1983) Myasthenia gravis. In: Hopf HC, Poeck K, Schliack H (eds) Neurologie in Praxis und Klinik, vol II. Thieme, Stuttgart, pp 137–161
Howard JF, Sanders DB (1983) The management of patients with Myasthenia gravis. In: Albuquerque EX, Eldefrawi AT (eds) Myasthenia gravis. Chapman and Hall, London, pp 457–490
Jaretski A (1978) Total thymectomy. Symposium of Myasthenia gravis. Trans Am Neurol Assoc 103:288–291
Krivit W, Scott Giebink G, Leonard A (1979) Overwhelming postsplenectomy infection. Surg Clin North Am 59:223–233
Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD (1976) Antibodies to acetylcholine receptor in myasthenia gravis. Neurology (Minneap) 26:1054–1059
Mertens HG, Hertel G, Reuther P, Ricker K (1981) Effect of immunosuppressive drugs (Azathioprine). In: Grob D (ed) Myasthenia gravis. Ann NY Acad Sci 377:691–699
Monnier VM, Fulpius BW (1977) A radioimmunoassay for the quantitative evaluation of antihuman acetylcholine receptor in myasthenia gravis. Clin Exp Immunol 29:16–22
Newsom-Davis J, Hawkey C, Vincent A (1981) Plasma exchange in the treatment of myasthenia gravis. In: Borberg H, Reuther P (eds) Plasma exchange therapy. Thieme, Stuttgart, pp 180–185
Olanow WC, Russell JM, Roses AD (1982) Thymectomy in late-onset Myasthenia gravis. Arch Neurol 39:82–83
Osterhuis HJ (1981) Observations of the natural history of myasthenia gravis and the effect of thymectomy. In: Grob D (ed) Myasthenia gravis. Ann NY Acad Sci 377:678–690
Resch K, Gemsa D (1983) Immunsystem. In: Vorländer KO (ed) Immunologie. Thieme, Stuttgart, pp 2–42
Reuther P, Wiebecke D, Fateh-Moghadam A, Besinger UA, Mertens HG (1981) The role of plasma exchange in the treatment of myasthenia gravis. In: Borberg H, Reuther P (eds) Plasma exchange therapy. Thieme, Stuttgart, pp 186–193
Stump WJ, Adornato BT, Engel WK, McIntosh CL, Castleman BJ (1978) Thymectomy in myasthenia gravis. Neurology (Minneap) 28:372–373
Wekerle H, Ketelsen U (1983) Myasthenia gravis. In: Vorländer KO (ed) Immunologie. Thieme, Stuttgart, pp 570–581
Wekerle H, Ketelsen UP, Zurn AP, Fulpius BW (1978) Intrathymic pathogenesis of myasthenia gravis: transient expression of acetylcholine receptors on thymus-derived muscle cells. Eur J Immunol 8:579–583
Winkelmeyer M, Littmann K, Thraenhart O, Tichy G, Kuwert EK, Eigler FW (1981) Veränderungen des humoralen und zellulären Immunsystems nach Splenektomie. Klin Wochenschr 59:485–493
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Hofmann, W.E., Reuther, P., Schalke, B. et al. Splenectomy in myasthenia gravis: a therapeutic concept?. J Neurol 232, 215–218 (1985). https://doi.org/10.1007/BF00313782
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DOI: https://doi.org/10.1007/BF00313782