A Clinical Study on Crises in Myasthenia Grav is

J Korean Neurol Assoc > Volume 2(1); 1984 > Article

Journal of the Korean Neurological Association 1984;2(1): 29-39.

중증근무력증에 있어 위기에 관한 임상적 고찰

정진상, 명호진

서울대학교 신경과.

A Clinical Study on Crises in Myasthenia Grav is

Jin-Sang Cheong, M.D., Ho-Jin Myong, M.D.

Department of Neurology, Seoul National University, Korea

Abstract

The authors reviewed the medical records of 103 patients who were diagnosed and treated as myasthenia gravis (MG)at Seoul National University Hospital from March 1979 to March 1984. Among them 16 cases were selected according to the criteria of crisis in MG defined by Blaugrund SM et al(1964) and were studied with a special emphasis on crisis as a natural course of MG in Korea. The authors studied about the incidence of crisis, the aggravating factors or causes, the relationship between crisis and thymus pathology, and the clinical appllcability of the modified classification of crises in MG including a newly-defined steroid-inducd crisis. The results were not significantly different from those by others in general. The incidence rate of crisis was 16% and highest in the female group having the onest of MG in the fourth decade of life. Four patients(25%) had thymomas(2, noninvasive: 2, invasive). The intervals between the onset of MG and the first crises were significantly shorter in male patients and thymoma group, showing the more fulminant course in them. Some probable risk factors were suggested, though not analyzed statistically, which might foretell the prognosis of each patient having MG and might help management and prevention of crisis. They were as follows: (1) Female with onset of MG in her fourth decade, (2) Male with duration less than one year, (3) Patient with thymoma, (4) Patient classified into Osserman's group III, (5) Patient with brittle MG, (6) Patient with an infectious process, especially with repiratory infection Early detection of respiratory insufficiency, intensive respiratory care, and removal of aggravating causes as soon as possible played the critical role in the management of patients at crises. It could also be concluded that steroid therapy was an important therapeutic step during crisis in brittle myasthenics. The outcome of crises was 19% of fatality rate in crises(3 deaths among 16 cases) and 3% mortality rate in MG. There was no recurrence in 11 survivors and followup was lost in two other survivors.