Comparison of Clinical Manifestations between Patients with Ocular Myasthenia Gravis and Generalized Myasthenia Gravis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To compare the clinical manifestations between patients with ocular myasthenia gravis and those with generalized myasthenia gravis (MG). Methods: The medical records of 71 patients diagnosed with MG between January 1995 and December 2007 were reviewed. Demographics, sensitivities of diagnostic methods, the presence of systemic autoimmune diseases,ophthalmic complications caused by MG, and treatments were evaluated and compared. Results: Fourteen patients (20%) were diagnosed with ocular MG and 57 patients (80%) with generalized MG. Sensitivities of anti-acetylcholine receptor antibody and repetitive nerve stimulation tests were significantly higher in the generalized MG group (84%, 89%) compared to those in the ocular MG group (50%, 54%) (p = 0.011, p =0.008). The sensitivity of the neostigmine test was the highest in both groups (98% of generalized MG, 79% of ocular MG), and the difference between the two groups was borderline significant (p = 0.058). The most common symptoms were ptosis and diplopia, and both groups presented with pain, blurred vision, and tearing. Systemic autoimmune disease was more prominent in the generalized MG group (21%) than in the ocular MG group (14%),and steroid therapy was used more frequently in the generalized MG group (82%) than in the ocular MG group (57%). Ophthalmic complications associated with long-term steroid treatment were more profound in the generalized MG (30%) compared to those of the ocular MG (21%). Conclusions: The generalized MG group was associated with higher sensitivities to diagnostic tests, more systemic steroid use, higher ophthalmic complications caused by systemic autoimmune disease, and long-term steroid treatment compared to those of the ocular MG group.
Abstract
Purpose: To compare the clinical manifestations between patients with ocular myasthenia gravis and those with generalized myasthenia gravis (MG). Methods: The medical records of 71 patients diagnosed with MG between January 1995 and December 2007 were reviewed. Demographics, sensitivities of diagnostic methods, the presence of systemic autoimmune diseases,ophthalmic complications caused by MG, and treatments were evaluated and compared. Results: Fourteen patients (20%) were diagnosed with ocular MG and 57 patients (80%) with generalized MG. Sensitivities of anti-acetylcholine receptor antibody and repetitive nerve stimulation tests were significantly higher in the generalized MG group (84%, 89%) compared to those in the ocular MG group (50%, 54%) (p = 0.011, p =0.008). The sensitivity of the neostigmine test was the highest in both groups (98% of generalized MG, 79% of ocular MG), and the difference between the two groups was borderline significant (p = 0.058). The most common symptoms were ptosis and diplopia, and both groups presented with pain, blurred vision, and tearing. Systemic autoimmune disease was more prominent in the generalized MG group (21%) than in the ocular MG group (14%),and steroid therapy was used more frequently in the generalized MG group (82%) than in the ocular MG group (57%). Ophthalmic complications associated with long-term steroid treatment were more profound in the generalized MG (30%) compared to those of the ocular MG (21%). Conclusions: The generalized MG group was associated with higher sensitivities to diagnostic tests, more systemic steroid use, higher ophthalmic complications caused by systemic autoimmune disease, and long-term steroid treatment compared to those of the ocular MG group.
참고문헌 (33)
- Kaminski HJ, "Why are eye muscles frequently involved in myasthenia gravis?", Neurology, 40, pp.1663~1669 (1990)
- Grob D, "The course of myasthenia gravis and therapies affecting outcome", Ann N Y Acad Sci, 505, pp.472~499 (1987)
- Robertson NP, "Myasthenia gravis:a population based epidemiological study in Cambridgeshire,England", J Neurol Neurosurg Psychiatry, 65, pp.492~496 (1998)
- Sommer N, "Ocular myasthenia gravis.A critical review of clinical and pathophysiological aspects", Doc Ophthalmol, 84, pp.309~333 (1993)
- Bever CT Jr, "Prognosis of ocular myasthenia", Ann Neurol, 14, pp.516~519 (1983)
- Kupersmith MJ, "Beneficial effects of corticosteroids on ocular myasthenia gravis", Arch Neurol, 53, pp.802~804 (1996)
- Sommer N, "Ocular myasthenia gravis:response to long-term immunosuppressive treatment", J Neurol Neurosurg Psychiatry, 62, pp.156~162 (1997)
- Kupersmith MJ, "Development of generalized disease at 2 years in patients with ocular myasthenia gravis", Arch Neurol, 60, pp.243~248 (2003)
- Monsul NT, "The effect of prednisone on the progression from ocular to generalized myasthenia gravis", J Neurol Sci, 217, pp.131~133 (2004)
- Agius MA, "Treatment of ocular myasthenia with corticosteroids:yes", Arch Neurol, 57, pp.750~751 (2000)
- Kupersmith MJ, "Does early treatment of ocular myasthenia gravis with prednisone reduce progression to generalized disease?", J Neurol Sci, 217, pp.123~124 (2004)
- Kupersmith MJ, "Ocular motor dysfunction and ptosis in ocular myasthenia gravis:effects of treatment", Br J Ophthalmol, 89, pp.1330~1334 (2005)
- Busch C, "Long-term outcome and quality of life after thymectomy for myasthenia gravis", Ann Surg, 224, pp.225~232 (1996)
- Beekman R, "Myasthenia gravis:diagnosis and follow-up of 100 consecutive patients", J Neurol, 244, pp.112~118 (1997)
- Donaldson DH, "The relationship of age to outcome in myasthenia gravis", Neurology, 40, pp.786~790 (1990)
- Oh SJ, "Diagnostic sensitivity of the laboratory tests in myasthenia gravis", Muscle Nerve, 15, pp.720~724 (1992)
- Benatar M, "A systematic review of diagnostic studies in myasthenia gravis", Neuromuscul Disord, 16, pp.459~467 (2006)
- Golnik KC, "An ice test for the diagnosis of myasthenia gravis", Ophthalmology, 106, pp.1282~1286 (1999)
- 황상준, "안검하수를 보이는 중증근무력증 진단에 있어서의 얼음검사의 유용성", 대한안과학회지, 46(10), pp.1611~1617 (2005), 대한안과학회
- Allen JA, "Ocular myasthenia gravis in a senior population:diagnosis,therapy and prognosis", Muscle Nerve, 41, pp.379~384 (2010)
- Carr AS, "A systematic review of population based epidemiological studies in myasthenia gravis", BMC Neurol, 10, pp.46~ (2010)
- Koves IH, "Ocular myasthenia gravis and Graves disease in a 10-year-old child", J Child Neurol, 24, pp.615~617 (2009)
- Christensen PB, "Associated autoimmune diseases in myasthenia gravis.A population-based study", Acta Neurol Scand, 91, pp.192~195 (1995)
- Antonio-Santos AA, "Medical treatment options for ocular myasthenia gravis", Curr Opin Ophthalmol, 19, pp.468~478 (2008)
- Diaz-Manera J, "Treatment strategies for myasthenia gravis", Expert Opin Pharmacother, 10, pp.1329~1342 (2009)
- Chirapapaisan N, "Factors associated with insensitivity to pyridostigmine therapy in Thai patients with ocular myasthenia gravis", Asian Pac J Allergy Immunol, 25, pp.13~16 (2007)
- Conti-Fine BM, "Myasthenia gravis:past,present,and future", J Clin Invest, 116, pp.2843~2854 (2006)
- Mee J, "Immunotherapy of ocular myasthenia gravis reduces conversion to generalized myasthenia gravis", J Neuroophthalmol, 23, pp.251~255 (2003)
- Tripathi RC, "Corticosteroids and glaucoma risk", Drugs Aging, 15, pp.439~450 (1999)
- Jobling AI, "What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts", Clin Exp Optom, 85, pp.61~75 (2002)
- Carvalho-Recchia CA, "Corticosteroids and central serous chorioretinopathy", Ophthalmology, 109, pp.1834~1837 (2002)
- Richman DP, "Myasthenia gravis:pathogenesis and treatment", Semin Neurol, 14, pp.106~110 (1994)
- Roberts PF, "Thymectomy in the treatment of ocular myasthenia gravis", J Thorac Cardiovasc Surg, 122, pp.562~568 (2001)