Splenectomy in myasthenia gravis: a therapeutic concept?

Abstract

The case histories are presented of five patients with long-diagnosed myasthenia gravis (up to 15 years) who underwent splenectomy. A precondition for the decision to operate was muscle weakness that could not be controlled with standard therapy (e.g. anticholinesterase drugs, immunosuppressive measures). After splenectomy, a considerable improvement took place in three cases; in one case there was moderate improvement, and in another, no improvement. The alleviation of myasthenia gravis may be attributable to the reduction of either the number of immunocompetent lymphocytes in an important storage organ or of the total bulk of the immune system in an immune disease with raised auto-antibody production. The acetylcholine receptor antibody titre was not affected by the operation in a consistent way. After splenectomy, immunosuppressive medication was tolerated better with respect to its haematological side-effects.