Management of juvenile/adult-onset myasthenia gravis at the Queen Elizabeth Hospital, Barbados

ABSTRACT

This paper is retrospective study of the management of myasthenia gravis (MG) in Barbados. The clinical experience, including an analysis of the role of thymectomy in the management of its disease, has been reviewed. Of 41 patients who were diagnosed as having MG six were excluded because of the onset below the age of twelve. Of the 35 patients studied, 15 had severe disease (Classes III-V) and 10 of these severely affected patients underwent thymectomy, the majority (70 percent) by the trans-cervical route. Follow up was available on all of the patients undergoing thymectomy and 15 of the patients on medical therapy (Classes II-V). Patients undergoing trans-cervical thymectomy had a better overall response than those treated medically, as measured by being able to get off drugs completely or being asymptomatic on a reduced drug dosage. Two of the patients had thymomas, on benign and the other malignant. The patient with the benign thymoma is asymptomatic but still on drugs and the other patient is still in the postoperative phase. It is concluded that in severe cases trans-cervical thymectomy produces a better overall response than medical treatment alone, and carries significantly less morbidity than the transternal approach in non-thymomatous cases.(AU)