Miastenia grave: avaliação clinica e terapêutica de 55 casos

Abstract

Foram estudados 55 casos de miastenia grave, avaliando os sinais e sintomas clínicos que ocorreram no início e na evolução dos pacientes, bem como os procedimentos diagnósticos e avaliação das medidas terapêuticas utilizadas. No manejo dos pacientes foram utilizados anticolinesterásicos, corticoesteróides, azathioprina, plasmaferese e timectomia, sem que fosse possível encontrar relação estatística significante entre os diferentes procedimentos com respeito à resolução da doença. Dos 55 casos, 9 (16,6%) obtiveram remissão total, 41 (74,5%) permaneceram com a doença ativa necessitando de tratamento sintomático e 5 (9.09%) faleceram. Houve relação estatística significante entre os sinais de insuficiência respiratória, crises miastênicas e timoma somente no grupo de pacientes que faleceram (um por insuficiência respiratória restritiva secundária a cifoescoliose severa, três com timoma e um caso durante a timectomia).It is reported the study of 55 myasthenia gravis cases, with a review of the symptoms and signals, comparing initial symptoms ant those found at the time of the first evaluation. The mean age of the patients was 31.05 ± 18.46 and the mean time of follow-up 5.88 ± 5.47 years. Also the results of the diagnostic tests is reported, as well as the results of the treatment. The patients were treated with anticholinesterasics, corticoesteroids, azathioprine, plasma-exchange and thymectomy. A statistical analysis with the chi-square test was unable to show a difference between the above procedures, regarding the definitive resolution of the disease. From the 55 cases, 9 (16.6%) had total remission, 41 (74.5%) remained with symptoms and need some kind of treatment, and 5 (9.09%) died (three patients with thymoma, one patient with congenital myasthenia gravis, severe cyphoscoliosis and pulmonary restriction, and one patient during the thymectomy procedure). It was found a relation between the signs of respiratory insuficiency, myasthenic crisis and thymoma only in the group of patients who died. A review about the diagnostic methods and treatment in the current days is made.