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Thymectomy for inducing remission in juvenile myasthenia gravis

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Abstract

Purpose

The aim of this study was to determine the efficacy of thymectomy to induce remission in juvenile myasthenia gravis.

Methods

A retrospective review of all patients undergoing a thymectomy for the treatment of juvenile myasthenia gravis was performed at a single tertiary referral centre between 1997 and 2009 (N = 8). All cases were moderate to severe cases (Osserman stage ≥ 2a). All operations were open. Median follow-up was 18 months (range 1–77). Postoperative progress was assessed using the De Filippi classification of remission.

Main results

Only two minor complications were reported. Mean operative time was 120 min (range 80–290 min). Mean postoperative stay was 17 days (range 3–52 days). Remission was observed in 5 of 8 patients (62%) at last known follow up.

Conclusions

Spontaneous remission rates for myasthenia gravis are quoted to be between 20 and 29% while remission rates following thymectomy are 29–68% at 3 years. Although not all of our patients have had 3 years of follow up—the remission rate of 62% demonstrated by this study is encouraging. If reproducible over a larger series this provides evidence of the efficacy of thymectomy for treating juvenile myasthenia gravis in selected patients.

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References

  1. Drachman DB (1994) Myasthenia gravis. N Engl J Med 330(25):1797–1810. doi:10.1056/NEJM199406233302507

    Article  PubMed  CAS  Google Scholar 

  2. Oosterhuis HJ (1989) The natural course of myasthenia gravis: a long term follow up study. J Neurol Neurosurg Psychiatry 52(10):1121–1127

    Article  PubMed  CAS  Google Scholar 

  3. Herrmann DN, Carney PR, Wald JJ (1998) Juvenile myasthenia gravis: treatment with immune globulin and thymectomy. Pediatr Neurol 18(1):63–66

    Article  PubMed  CAS  Google Scholar 

  4. Yi Q, Lefvert AK (1994) Idiotype- and anti-idiotype-reactive t lymphocytes in myasthenia gravis. Evidence for the involvement of different subpopulations of t helper lymphocytes. J Immunol 153(7):3353–3359

    PubMed  CAS  Google Scholar 

  5. Conti-Fine BM, Milani M, Kaminski HJ (2006) Myasthenia gravis: past, present, and future. J Clin Invest 116(11):2843–2854. doi:10.1172/JCI29894

    Article  PubMed  CAS  Google Scholar 

  6. Lanska DJ (1990) Indications for thymectomy in myasthenia gravis. Neurology 40(12):1828–1829

    PubMed  CAS  Google Scholar 

  7. Zielinski M, Hauer L, Hauer J, Pankowski J, Nabialek T, Szlubowski A (2010) Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg 37(5):1137–1143. doi:10.1016/j.ejcts.2009.11.029

    Article  PubMed  Google Scholar 

  8. Kanzaki M, Obara T, Sasano S, Hikawa Y, Onuki T (2008) Long-term clinical outcome after extended thymectomy combined postoperative high-dose steroid therapy for juvenile myasthenia gravis. Ann Thorac Cardiovasc Surg 14(2):119–122

    PubMed  Google Scholar 

  9. Bachmann K, Burkhardt D, Schreiter I, Kaifi J, Busch C, Thayssen G, Izbicki JR, Strate T (2008) Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc 22(11):2470–2477. doi:10.1007/s00464-008-9794-2

    Article  PubMed  Google Scholar 

  10. Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, Pohl MS, Cooper JD (1999) Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 230(4):555–559 (discussion 559–561)

    Article  PubMed  CAS  Google Scholar 

  11. Masaoka A, Yamakawa Y, Niwa H, Fukai I, Kondo S, Kobayashi M, Fujii Y, Monden Y (1996) Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg 62(3):853–859

    Article  PubMed  CAS  Google Scholar 

  12. DeFilippi VJ, Richman DP, Ferguson MK (1994) Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 57(1):194–197

    Article  PubMed  CAS  Google Scholar 

  13. Kolski H, Vajsar J, Kim PC (2000) Thoracoscopic thymectomy in juvenile myasthenia gravis. J Pediatr Surg 35(5):768–770. doi:10.1053/jpsu.2000.6065

    Article  PubMed  CAS  Google Scholar 

  14. Kumar A, Kumar S, Ghanta R, Singh S, Pawar DK, Kalara V (2002) Thoracoscopic thymectomy for juvenile myasthenia gravis. Indian Pediatr 39(12):1131–1137

    PubMed  Google Scholar 

  15. Lakhoo K, Fonseca JD, Rodda J, Davies MRQ (1997) Thymectomy in black children with juvenile myasthenia gravis. Pediatr Surg Int 12(2/3):113–115

    Article  CAS  Google Scholar 

  16. Adams C, Theodorescu D, Murphy EG, Shandling B (1990) Thymectomy in juvenile myasthenia gravis. J Child Neurol 5(3):215–218

    Article  PubMed  CAS  Google Scholar 

  17. Wagner AJ, Cortes RA, Strober J, Grethel EJ, Clifton MS, Harrison MR, Farmer DL, Nobuhara KK, Lee H (2006) Long-term follow-up after thymectomy for myasthenia gravis: Thoracoscopic vs open. J Pediatr Surg 41(1):50–54. doi:10.1016/j.jpedsurg.2005.10.006 (discussion 50–54)

    Article  PubMed  Google Scholar 

  18. de Assis JL, Marchiori PE, Zambon AA, Scaff M (1992) Juvenile myasthenia gravis and thymectomy: Report of ten cases. Rev Hosp Clin Fac Med Sao Paulo 47(5):234–236

    PubMed  Google Scholar 

  19. Lindner A, Schalke B, Toyka KV (1997) Outcome in juvenile-onset myasthenia gravis: a retrospective study with long-term follow-up of 79 patients. J Neurol 244(8):515–520

    Article  PubMed  CAS  Google Scholar 

  20. Rodriguez M, Gomez MR, Howard FM Jr, Taylor WF (1983) Myasthenia gravis in children: long-term follow-up. Ann Neurol 13(5):504–510. doi:10.1002/ana.410130506

    Article  PubMed  CAS  Google Scholar 

  21. Ryniewicz B, Badurska B (1977) Follow-up study of myasthenic children after thymectomy. J Neurol 217(2):133–138

    Article  PubMed  CAS  Google Scholar 

  22. Seybold ME, Howard FM Jr, Duane DD, Payne WS, Harrison EG Jr (1971) Thymectomy in juvenile myasthenia gravis. Arch Neurol 25(5):385–392

    PubMed  CAS  Google Scholar 

  23. Osserman KE, Genkins G (1971) Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. Mt Sinai J Med 38(6):497–537

    PubMed  CAS  Google Scholar 

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Correspondence to Iain A. M. Hennessey.

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Hennessey, I.A.M., Long, A.M., Hughes, I. et al. Thymectomy for inducing remission in juvenile myasthenia gravis. Pediatr Surg Int 27, 591–594 (2011). https://doi.org/10.1007/s00383-010-2837-5

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