Myasthenic ophthalmoparesis: Time To resolution after initiating immune therapies.

Abstract

INTRODUCTION:

Although immunotherapies such as prednisone are effective in treating myasthenic muscle weakness, their effect on resolution of myasthenic-induced persistent ophthalmoparesis is unknown.

METHODS:

We observed patients with myasthenia gravis during their first year of immunotherapy, documenting ophthalmoplegia scores and drug doses.

RESULTS:

Seventy-six of 87 cases had persistent ophthalmoparesis. With immunotherapy, the median time to resolution of ophthalmoparesis was 7 months, and 37% of cases resolved within 3 months. Patients starting therapy within 12 months of symptom onset were twice as likely to have resolution in the first year (P = 0.028). Resolution of ophthalmoparesis within 3 months, compared with later resolution, was associated with higher initial prednisone doses (mean 0.5 vs. 0.3 mg/kg/day; P = 0.014). However, 25% of the higher dose group also received intravenous immunoglobulin/plasma exchange; after their exclusion, the finding was not significant.

DISCUSSION:

One-third of cases with myasthenic ophthalmoparesis resolved within 3 months of immunotherapy, particularly in response to more aggressive immunotherapy. Muscle Nerve 58: 542-549, 2018.

• Authors: Tarin A Europa, Melissa Nel, Jeannine M Heckmann
• Journal: Muscle & nerve (Muscle Nerve) Vol. 58 Issue 4 Pg. 542-549 (10 2018) ISSN: 1097-4598 [Electronic] United States
• PMID: 29790193 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 Wiley Periodicals, Inc.

Chemical References

• Glucocorticoids
• Immunoglobulins, Intravenous
• Immunologic Factors
• Immunosuppressive Agents
• Azathioprine
• Prednisone
• Methotrexate

Topics

• Adult
• Azathioprine (therapeutic use)
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunologic Factors (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Middle Aged
• Myasthenia Gravis (complications, physiopathology, therapy)
• Ophthalmoplegia (etiology, physiopathology, therapy)
• Plasma Exchange
• Prednisone (therapeutic use)
• Proportional Hazards Models
• Recovery of Function
• Time Factors
• Treatment Outcome
• Young Adult