Contemporary treatment of myasthenia gravis

Cilj istraživanja: Analiza liječenja miastenije gravis na Klinici za neurologiju KBC-a Split u petogodišnjem razdoblju (2012.-2016.g) i utvrđivanje suvremenosti liječenja. Materijali i metode: Retrospektivno su iz povijesti bolesti pohranjenima u arhivi KBC-a Split prikupljeni podaci o pacijentima hospitaliziranima na Klinici za neurologiju pod dijagnozom miastenije gravis u razdoblju od 1. siječnja 2012. godine do 31. prosinca 2016. godine. Prikupljeni su i analizirani podaci o spolu, dobi, prijemu, otpustu, trajanju hospitalizacije, neurološkom te serološkom statusu, nalazima prostigminskog testa i testa neuromuskularne spojnice, nalazu MSCT-a toraksa, te terapiji koji su primali prije, tijekom i nakon hospitalizacije. Rezultati: Analiza je provedena na 63 pacijenata prosječne dobi 61 godina, od toga su 43 žene i 17 muškaraca. Zabilježene su 83 hospitalizacije prosječnog trajanja 11 dana. Gotovo 60% pacijenata hospitalizirano je hitnim prijemom, a ishod većine hospitalizacija (74%) je poboljšanje. Kod pacijenata koji su više puta hospitalizirani, analiza statusa, dijagnostičkih testova i terapije obavljena je prema podacima iz prve hospitalizacije. 18 od 49 testiranih pacijenata ima pozitivna anti-AchR antitijela, a niti jedan od 36 testiranih nema pozitivna anti-Musk antitijela. Piridostigmin je već pri prijemu uzimalo 22 pacijenata, a za vrijeme hospitalizacije njih 57, što je značajna razlika. Ostale terapije (prednizon, azatioprin i mikofenolat mofetil) se nisu značajno razlikovale prije, tijekom i nakon hospitalizacije. Za vrijeme hospitalizacije, 2 bolesnika je primalo IVIg, a kod 10 njih je urađena plazmafereza. Zaključak: Na temelju analize podataka prikupljenih istraživanjem te njihove usporedbe s novijim podacima iz svjetske literature možemo zaključiti da je liječenje miastenije gravis na Klinici za neurologiju KBC-a Splitu u skladu sa suvremenim liječenjem u svijetu.Objectives: Analysis of treatment of myasthenia gravis at the Department of Neurology, University Hospital Center Split in Split, Republic of Croatia in the five-year period (2012-2016) and determination of modernity of treatment. Matherials and methods: Data of patients hospitalized at the Clinic of Neurology under the diagnosis of myasthenia gravis in the period from January 1, 2012 to December 31, 2016 were retrospectively gathered from medical histories stored in the hospital archives. Data that were analysed included patients age, gender, type of hospital admission and discarge, duration of hospitalization, neurological and serological status, results of prostigmin test and neuromuscular junction testing, MSCT image of thorax and data about treatment before, during and after hospitalization. Results: The analysis was conducted on 63 patients with an average age of 61 years, out of which were 43 women and 17 men. There were 83 hospitalizations of an average duration of 11 days. Almost 60% of patients were admitted in hospital by emergency, and the outcome of most hospitalizations (74%) was an improvement. In patients who have been hospitalized several times, analysis of status, diagnostic tests and therapy was performed according to data from the first hospitalization. 18 out of 49 patients who have been tested for presence of anti-AchR antibodies had positive results, and none of the 36 tested had positive anti-MuSK antibodies. 22 patients were already taking pyridostigmine when admitted in hospital, and 57 during hospitalization, which is a significant difference. Other therapies (prednisone, azathioprine and mycophenolate mofetil) did not differ significantly before, during and after hospitalization. During hospitalization, 2 patients received IVIg and 10 of them received plasmapheresis. Conclusion: Based on the analysis of the data collected by the research and their comparation with the latest data from the world literature we can conclude that the treatment of myasthenia gravis at the Department of Neurology in University Hospital Center Split is in accordance with contemporary treatment in the world