Neurology Research Group, Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Muscle Nerve. 2018 Oct;58(4):542-549. doi: 10.1002/mus.26172. Epub 2018 Aug 1.
Although immunotherapies such as prednisone are effective in treating myasthenic muscle weakness, their effect on resolution of myasthenic-induced persistent ophthalmoparesis is unknown.
We observed patients with myasthenia gravis during their first year of immunotherapy, documenting ophthalmoplegia scores and drug doses.
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.
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.
尽管泼尼松等免疫疗法可有效治疗重症肌无力引起的肌肉无力，但它们对重症肌无力引起的持续性眼肌麻痹的缓解效果尚不清楚。
我们观察了接受免疫治疗的重症肌无力患者在免疫治疗的第一年中的情况，记录眼肌麻痹评分和药物剂量。
76 例 87 例患者存在持续性眼肌麻痹。在免疫治疗中，眼肌麻痹缓解的中位时间为 7 个月，37%的病例在 3 个月内缓解。症状发作后 12 个月内开始治疗的患者在第一年中有两倍的可能性得到缓解（P=0.028）。与晚期缓解相比，3 个月内缓解的眼肌麻痹与更高的初始泼尼松剂量相关（平均 0.5 与 0.3mg/kg/天；P=0.014）。然而，25%的高剂量组也接受了静脉注射免疫球蛋白/血浆置换；排除他们后，这一发现就不显著了。
三分之一的重症肌无力眼肌麻痹患者在免疫治疗后 3 个月内得到缓解，尤其是对更积极的免疫治疗反应。肌肉神经 58:542-549,2018.
