Current management of myasthenia gravis in Belgium: a single-center experience

Abstract

Introduction: As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which patients would most likely benefit from the new treatments.

Methods: We reviewed the clinical files of all MG patients seen at the Department of Neurology of the Antwerp University Hospital during the years 2019, 2020 and 2021.

Results: 163 patients were included. Age at diagnosis varied from the first to the eighth decades, with a peak of incidence from 60 to 70 years for both genders, and an additional peak from 20 to 30 years in women. Diplopia and ptosis were by far the most common onset symptom. At maximum disease severity, 24% of the patients still had purely ocular symptoms and 4% needed mechanical ventilation. 97% of the patients received a treatment with pyridostigmine and 68% with corticosteroids, often in combination with immunosuppressants. More than half reported side effects. At the latest visit, 50% of the patients were symptom-free. Also, half of the symptomatic patients were fulltime at work or retired with no or mild limitations in daily living. The remaining patients were working part-time, on sick leave, or retired with severe limitations.

Discussion and conclusion: The majority of MG patients are doing well with currently available treatments, but often at the cost of side effects in the short and in the long term. A significant group is in need of better treatments.

Keywords: Autoantibodies; Electromyography; Myasthenia gravis; Treatment.

Fig.1

Age at diagnosis. Horizontal axis age in years, vertical axis number of patients

Fig. 2

First symptom in 163 patients

Fig. 3

MGFA clinical classification at time of diagnosis, maximum disease severity and last visit. Class 1 indicates only ocular weakness, classes 2, 3 and 4 indicate, respectively, mild, moderate and severe generalized weakness with ocular and limb predominance in “a” and bulbar and respiratory predominance in “b”. Class 5 indicates intubation for ventilation. At the last visit, patients with no MG symptoms and normal clinical examination were attributed to a fictive MGFA class 0

Fig. 4

Time interval in years between diagnosis and last visit