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Acta Myol. 2009 July; 28(1): 45–46.
PMCID: PMC2859660

P-5 Diagnosis and treatment of myasthenia gravis in Cyprus

This was a retrospective study of all patients treated for myasthenia gravis (MG) in Neurology Clinic E at the Cyprus Institute of Neurology and Genetics. Epidemiological data, antibody status and clinical severity using the MG Foundation of America score in relation to treatment were assessed. Results: 36 females and 24 males were included in the study (M:F ratio 1:1.5). Average age at onset in females was 41 years (range 12-75 years) and in males 43 years (range 16-67 years). Clinical diagnosis in the majority (95%) of patients was confirmed by single fiber EMG (SFEMG) and/or with repetitive nerve stimulation (13,3%). Onset was with ocular manifestations in 26.7% of patients, bulbar weakness in 61.7%, and limb weakness in 11.6%. At maximum disease severity 21.6% of patients had severe bulbar weakness, and 13.3% required intubation. Following various treatments the majority of patients are currently asymptomatic (23.3%) or have only ocular (41.6%) or mild generalized weakness (28.3%). Autoimmune thyroid disease, vitamin B12 deficiency and asthma are commonly associated disorders. 29.6% of generalized MG patients had AchR-Ab, 18.6% had MuSK-Ab, and 22.2% were double seronegative. 29,6% are seronegative for AchR-Ab but have not yet been tested for MuSK-Ab. MuSK Ab+ patients appear to have slightly more severe course than Ach-R Ab+ or seronegative patients. Thymectomy was performed in 24% of generalized MG patients and increased the chances of remission when done early and in the absence of neoplasm. Most patients were treated with combination of corticosteroids and steroid-sparing medications, mostly Azathioprine and mycophenolate preparations. Addition of mycophenolate in patients with moderate to severe disease significantly improved outcome and had a steroid sparing effect. Side effects occurred with all treatments. Conclusions: There is an unusual high proportion of seronegative MG patients in Cyprus. Further research on the auto-immune mechanisms is required. Most patients improve with combination of treatments currently available, but side effects remain problematic. Mycophenolate appears to be safe and effective for selected MG patients.

Articles from Acta Myologica are provided here courtesy of Pacini Editore