Effect of Steroid Treatment in Myasthenia Gravis

J Korean Neurol Assoc > Volume 3(1); 1985 > Article

Journal of the Korean Neurological Association 1985;3(1): 63-71.

중증근무력증에서의 스테로이드 치료효과

노재규, 정진상, 서만욱, 박성호,전범석,권오상, 이상복, 명호진

서울대학교 신경과.

Effect of Steroid Treatment in Myasthenia Gravis

Jae-Kyue No, M.D.,Ho-Jin Myung, M.D., Sang-Bock Lee, M.D., Jong-Sung Kim, M.D., Jin-Sang Jung, M.D., Man-Wook Seo, M.D., Sung-Ho Park, M.D., Bum-Suk Jun, M.D., O-Sang Kwon, M.D.

Department of Neurology, Seoul National University

Abstract

Twenty-one myasthenic patients were treated with high-dose daily prednisone regimen at Seoul National University Hospital from May 1983 to January 1985. Observations in relation to dosage, drug schedule, clinical responses, and sideeffects led us to following conclusions concerning the management of myasthenia gravis with steroid. In addition, factors influencing the result were considered. 1) Among 21 patients, twenty(95%) showed clinical improvement of variable degrees. 2) Significant improvement could be expected especially in male patients, in older patients, and in those with duration of myasthenia gravis less than 6 months prior to treatment. Performance of thymectomy or thymothymectomy, thymic pathology, and clinical grade at the time of therapy were not considered to affect the outcome. 3) Ten cases (48%) suffered from initial exacerbations, most of which occurred within the first four days of treatment. Steroid-induced crises developed in four cases with preexisting brittle or severe generalized myasthenia. 4) Period taken to show the initial response and the maximum improvement varied widely but majority of them occurred within 15 days and 70 days respectively. 5) Off-day weakness during the alternate-day schedule required special cautions and, if persitent, immediate return to daily schedule was desirable. 6) Thymectomy prior to steroid treatment was not always necessary but, when both regimens were scheduled together, preparation therapy with steroid thought to be more favorable. 7) Aside from initial exacerbations side-effects during the treatment were not remarkable, all of which disappeared with reduction of dosage.