%0 Journal Article
%T Preoperative High-Dose Steroid Has Long-Term Beneficial Effects for Myasthenia Gravis
%A Syuichi Tetsuka
%A Ken-ichi Fujimoto
%A Kunihiko Ikeguchi
%J Neurology Research International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/709480
%X Previous studies addressing preoperative steroid treatment have revealed that control of myasthenia gravis (MG) with steroids prior to surgery appeared to stabilize postoperative status. The purpose of our study was to clarify the clinical benefits of the preoperative programmed high-dose steroid treatment on the long-term outcomes of MG patients. We retrospectively reviewed the records of 171 MG patients who were followed up after undergoing thymectomy in our hospital between 1988 and 2006. One hundred and thirteen patients in the programmed treatment group had received preoperative steroid treatment, while 58 patients received no steroid treatment during the preoperative period. Clinical remission, which was defined as the achievement of the modified pharmacologic remission (PR) for at least 1 year, and clinical benefits were compared between the two groups. With regard to the remission after thymectomy, Kaplan-Meier life-table curves for patients in the preoperative steroid treatment group versus those for patients in the no steroid preoperative treatment group revealed a significantly higher probability of the PR in the preoperative steroid treatment group (log-rank test, ). This study might be the first, as per our knowledge, to indicate that preoperative programmed high-dose steroid treatment has long-term beneficial effects for MG patients. 1. Introduction The prognosis of myasthenia gravis (MG) has improved dramatically because of advances in critical care medicine and symptomatic treatments. The immunopathogenesis of MG is fundamentally a T-cell-dependent autoimmune process resulting from loss of tolerance toward self-antigens in the thymus. Thymectomy is based on this immunological background. MG patients that cannot be controlled with adequate symptomatic treatment or those who fail to achieve remission after thymectomy usually achieve remission after the addition of other immunotherapies. Steroids are the firstline of immunosuppressive treatment and the most consistently effective treatment for MG. Several studies of steroid treatment for MG found that remission or a marked improvement occurred in approximately 80% cases, and high-dose steroids are universally preferred for remission induction [1]. Immunosuppressive treatment comprising alternate-day administration of steroids before thymectomy was reported by Yamaguchi and associates to help stabilize the patient¡¯s condition after surgery [2]. MG patients have undergone thymectomy after programmed high-dose steroid treatment at our hospital since 1991. Endo et al. reported that programmed
%U http://www.hindawi.com/journals/nri/2013/709480/