Management of Thymectomized Myasthenic Patients

Abstract

Up to now the exstirpation of thymus gland stands in the central position of the immuno-therapeutic strategy of myasthenia gravis promising alone the chance of total and definitive recovery in some cases. FIGURE 1. The current antigen-specific therapeutical approaches inducing autoimmune unresponsiveness to acetylcholin receptor are still in experimental phase.(ref. 1) They certainly need a rather long period until one or more of them will be applied in humans. This is the reason why the therapeutic centers elaborated new management for the therapy-resistant patients.(ref. 2, 3, 4, 5). FIGURE 2. In some dubious cases the diagnosis of myasthenia gravis and the indication of thymectomy are difficult and need a long-lasting observation. The benefit from maintaining anticholinesterase therapy, the significant respond to plasma-exchange in crisis, the secondary generalization of ocular symptoms and the electrodiagnostic tests becoming positive after some years all strengthen the indication for thymectomy. FIGURE 3. As you can see on the third figure the indication of immunotherapies other than thymectomy has pro- and contra-arguments. We used to apply these methods at thymectomy unresponders, elderly X-ray unresponders, pregnants in crisis-prone state and in anticholinesterase resistance or intolerance. The crisis tendency is the major reason for applying these expensive therapies, but decreasing the drug doses and making rare the myasthenic relapses in the interest of improving life-quality are not negligible standpoints, either. FIGURE 4. In some severe cases both the plasma-exchange and the high-dose intravenous methylprednisolon infusion as well as the repeated high-dose intravenous immunoglobulin therapy may unfortunately fail.(ref. 6, 7, 8) All these observations induced us preparing new effectual therapeutic pattern.