A Follow-up for Myasthenia Gravis after Low Dose Whole Body Irradiation

J Korean Neurol Assoc > Volume 19(6); 2001 > Article

Journal of the Korean Neurological Association 2001;19(6): 619-623.

중증근무력증의 저용량 전신방사선요법 : 추적 관찰

이규용, 이영주 김희태 김승현 김주한 김명호

한양대학교 의과대학 신경과학교실

A Follow-up for Myasthenia Gravis after Low Dose Whole Body Irradiation

"Kyu-Yong Lee, M.D., Young Joo Lee, M.D., Hee-Tae Kim, M.D., Seung-Hyun Kim, M.D., Juhan Kim, M.D., Myung-Ho Kim, M.D."

Department of Neurology, Collage of medicine, Hanyang University

Abstract

"Background : Whole body irradiation (WBI) for myasthenia gravis is known to produce prolonged immunosuppres-sion with rare side effects. This study evaluated the duration of immunosuppression effects of WBI for long-term fol-low-up and decision time of ‘booster’ WBI treatments by analyzing clinical symptoms and laboratory findings. Methods : We studied 11 patients with intractable myasthenia gravis. All patients had been treated with WBI and were followed for at least 5 years except for 2 patients died. Clinical status and immunological parameters were assessed at baseline and every year after the initial dose of irradiation. During the follow-up period, patients with declining clinical or immunological parameters were given ‘booster’ WBI treatments. Results : WBI was associated with objective clini-cal improvements in seven patients: 3 patients had none or mild symptoms without any medications, 3 patients had ‘booster’ WBI treatments at 34 months(25-40 months) due to clinical or immunological declines, 1 patient had a stable clinical course with anticholinesterase medication. WBI was associated with clinical decline or no change in four patients: 2 patients died and 2 patients did not experience a change in clinical status. WBI produced a long-lasting lym-phopenia for more than 2 years with decreased absolute lymphocytes counts. There was no statistical differences in clinical and immunological parameters between the ‘booster’ WBI groups and non-‘booster’ WBI groups in good responders. ‘Booster’ WBI patients had no significant side effects. Conclusions : WBI has an effective therapeutic modality in intractable long-term myasthenia gravis. In this study, the duration of immnunosuppression effects of WBI was found to last 2 years. It is suggested that patients with declining clinical or immunological parameters be given ‘booster’ WBI treatments. Key Words : Whole body irradiation, ‘Booster’ whole body irradiation, Myasthenia gravis, Treatment method."