The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Henry J Kaminski - One of the best experts on this subject based on the ideXlab platform.
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Ocular Myasthenia.
Neurologic clinics, 2018Co-Authors: Mohammed Al-haidar, Michael Benatar, Henry J KaminskiAbstract:Ocular Myasthenia is a form of Myasthenia gravis in which weakness is restricted to the Ocular muscles and may produce significant visual disability. Patients present with fluctuating ptosis, diplopia, or a combination of both. Examination may show any type of Ocular motility deficit ranging from isolated muscle palsy to complete ophthalmoplegia. Cogan lid twitch, enhanced ptosis, peek sign, and saccadic fatigue are specific examination findings that support the clinical diagnosis of Myasthenia gravis. Confirmation of the diagnosis is challenging with autoantibody serology, and repetitive nerve stimulation studies are often negative.
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medical and surgical treatment for Ocular Myasthenia
Cochrane Database of Systematic Reviews, 2012Co-Authors: Michael Benatar, Henry J KaminskiAbstract:BACKGROUND Approximately 50% of people with Myasthenia gravis present initially with purely Ocular symptoms, so called Ocular Myasthenia and between 50 to 60% of these people will progress to develop generalized disease. The vast majority will do so within the first one to two years. There is controversy surrounding the appropriate management of patients with Ocular Myasthenia. OBJECTIVES To perform a systematic review of the literature relevant to the treatment of Ocular Myasthenia and to answer three specific questions. Are there any medical or surgical treatments that have an impact on the risk of progression from Ocular to generalized Myasthenia gravis? Are there any medical or surgical treatments that improve symptoms of diplopia or ptosis in Ocular Myasthenia? What is the frequency of side effects associated with treatments used in people with Ocular Myasthenia? SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (searched December 2004), MEDLINE (1996 to 2004) and EMBASE (1980 to 2004) for randomized controlled trials as well as case-control and cohort studies. The titles and abstracts of all articles were read by both authors and the full text of all articles that were of possible relevance was reviewed in full. The references of all manuscripts included in the review were scanned to identify additional articles of relevance and experts in the field were contacted to identify additional published and unpublished data. Where necessary and possible, we contacted authors for further information. SELECTION CRITERIA To be included in the review, studies had to meet three criteria: (a) randomized (or quasi-randomized) controlled study design; (b) active treatment compared to placebo, no treatment or some other treatment; and (c) results reported separately for patients with Ocular Myasthenia (grade 1) as defined by the Myasthenia Gravis Foundation of America. DATA COLLECTION AND ANALYSIS We collected data regarding the risk of progression to generalized Myasthenia gravis, improvement in Ocular symptoms, and the frequency of treatment-related side effects. MAIN RESULTS We identified two randomized controlled trials relevant to the treatment of Ocular Myasthenia, only one of which reported results in terms of the pre-specified outcome measures used in this review. This study included only three participants and was of limited methodological quality. In the absence of data from randomized controlled trials, we present a review of the available observational data. AUTHORS' CONCLUSIONS There are no data from randomized controlled trials on the impact of any form of treatment on the risk of progression from Ocular to generalized Myasthenia gravis. The available randomized controlled literature does not permit any meaningful conclusions about the efficacy of any form of treatment for Ocular Myasthenia. Data from several reasonably good quality observational studies suggest that corticosteroids and azathioprine may be beneficial in reducing the risk of progression to generalized Myasthenia gravis.
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The Cochrane Library - Medical and surgical treatment for Ocular Myasthenia
The Cochrane database of systematic reviews, 2012Co-Authors: Michael Benatar, Henry J KaminskiAbstract:BACKGROUND Approximately 50% of people with Myasthenia gravis present initially with purely Ocular symptoms, so called Ocular Myasthenia and between 50 to 60% of these people will progress to develop generalized disease. The vast majority will do so within the first one to two years. There is controversy surrounding the appropriate management of patients with Ocular Myasthenia. OBJECTIVES To perform a systematic review of the literature relevant to the treatment of Ocular Myasthenia and to answer three specific questions. Are there any medical or surgical treatments that have an impact on the risk of progression from Ocular to generalized Myasthenia gravis? Are there any medical or surgical treatments that improve symptoms of diplopia or ptosis in Ocular Myasthenia? What is the frequency of side effects associated with treatments used in people with Ocular Myasthenia? SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (searched December 2004), MEDLINE (1996 to 2004) and EMBASE (1980 to 2004) for randomized controlled trials as well as case-control and cohort studies. The titles and abstracts of all articles were read by both authors and the full text of all articles that were of possible relevance was reviewed in full. The references of all manuscripts included in the review were scanned to identify additional articles of relevance and experts in the field were contacted to identify additional published and unpublished data. Where necessary and possible, we contacted authors for further information. SELECTION CRITERIA To be included in the review, studies had to meet three criteria: (a) randomized (or quasi-randomized) controlled study design; (b) active treatment compared to placebo, no treatment or some other treatment; and (c) results reported separately for patients with Ocular Myasthenia (grade 1) as defined by the Myasthenia Gravis Foundation of America. DATA COLLECTION AND ANALYSIS We collected data regarding the risk of progression to generalized Myasthenia gravis, improvement in Ocular symptoms, and the frequency of treatment-related side effects. MAIN RESULTS We identified two randomized controlled trials relevant to the treatment of Ocular Myasthenia, only one of which reported results in terms of the pre-specified outcome measures used in this review. This study included only three participants and was of limited methodological quality. In the absence of data from randomized controlled trials, we present a review of the available observational data. AUTHORS' CONCLUSIONS There are no data from randomized controlled trials on the impact of any form of treatment on the risk of progression from Ocular to generalized Myasthenia gravis. The available randomized controlled literature does not permit any meaningful conclusions about the efficacy of any form of treatment for Ocular Myasthenia. Data from several reasonably good quality observational studies suggest that corticosteroids and azathioprine may be beneficial in reducing the risk of progression to generalized Myasthenia gravis.
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Ocular Myasthenia: diagnostic and treatment recommendations and the evidence base.
Current opinion in neurology, 2008Co-Authors: Uladzimir Luchanok, Henry J KaminskiAbstract:Purpose of review Increasing rigor is being applied to medical decision making, but Myasthenia gravis, commonly considered the best understood autoimmune disorder from a pathophysiological basis, lags other disciplines in the evidence base used to make clinical decisions. The review attempts to provide a focused, practical guideline for the diagnosis and treatment of Ocular Myasthenia within the limits of largely retrospective case series and expert opinion. Recent findings Confirmation of clinical diagnosis continues to be challenging for Ocular Myasthenia. Despite the recognition of a new autoantigen, the muscle-specific kinase protein in generalized Myasthenia gravis, it has been found to be only rarely identified in Ocular Myasthenia patients and therefore the majority of patients lack detectable autoantibodies and confirmation of a neuromuscular transmission disorder relies on specialized testing of single-fiber electromyography. The visual compromise of Ocular Myasthenia responds poorly to nonpharmacological and cholinesterase inhibitor therapy, and although corticosteroids are thought to be extremely effective, their toxicity is poorly defined in Ocular Myasthenia patients and whether they reduce the risk of development of generalized disease is not known. Summary Rigorous clinical trials or large databases with outcome assessments are necessary in order to allow development of rational treatment strategies.
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Ocular Myasthenia: diagnosis, treatment, and pathogenesis.
The neurologist, 2006Co-Authors: Linda L. Kusner, Araya Puwanant, Henry J KaminskiAbstract:Background:Although Myasthenia gravis (MG) is often considered the best-understood autoimmune disorder and effective treatments have controlled life-threatening complications, the pathogenesis of Ocular Myasthenia (OM) remains enigmatic, and its clinical consequences offer therapeutic challenges.Rev
Eric Eggenberger - One of the best experts on this subject based on the ideXlab platform.
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OMGRATS: a new rating scale for Ocular Myasthenia Gravis
Spencer S. Eccles Health Sciences Library University of Utah, 2019Co-Authors: Sui Wong, Eric Eggenberger, A Xhepa, Eduardo Miranda, H Lee, A Burke, Laura Dell'arti, Wayne Cornblath, Carolina BarnettAbstract:We present the first dedicated rating scale for Ocular Myasthenia Gravis (OMG), developed through an international collaboration between neuromuscular and neuro-ophthalmology experts in OMG. A robust and relevant rating scale for OMG is key in clinical trials for this condition. The rating scales recommended for MG research have a predominant focus on generalized disease, and are insufficiently sensitive for OMG. We developed the Ocular Myasthenia Gravis Rating Scale (OMGRATS) to better assess the fluctuations and severity of signs and symptoms caused by OMG
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Prognosis of Ocular Myasthenia Gravis: Retrospective Multicenter Analysis
Ophthalmology, 2015Co-Authors: Lina Nagia, Wayne T. Cornblath, João Lemos, Khawla Abusamra, Eric EggenbergerAbstract:Purpose To calculate the rate and timing of conversion from Ocular Myasthenia gravis to generalized Myasthenia gravis. Design Retrospective multicenter analysis. Subjects Patients included in the study were diagnosed with Ocular Myasthenia gravis without the presence of generalized disease at onset. Methods We conducted a retrospective multicenter analysis. We reviewed charts of 158 patients who met diagnostic criteria for Ocular Myasthenia gravis. Patients were divided into 2 subgroups: an immunosuppressant treatment group and a nonimmunosuppressant treatment group. Timing of conversion to generalized disease and duration of follow-up also was evaluated. Additional data such as clinical symptoms at presentation, laboratory test results, and chest imaging results also were recorded. Main Outcome Measures Conversion rates to generalized Myasthenia at 2 years, effect of immunosuppression on conversion, and timing of conversion. Results The 158-patient cohort included 76 patients who received immunosuppressant therapy; the remaining 82 patients did not. The overall conversion rate to generalized disease was 20.9%. At 2 years, generalized Myasthenia developed in 8 of 76 patients in the treated group and in 15 of 82 patients in the nonimmunotherapy group (odds ratio, 0.52; 95% confidence interval, 0.20–1.32). Median time for conversion to generalized disease was 20 months in the nonimmunosuppressant group and 24 months in the immunosuppressant group. Conversion occurred after 2 years of symptom onset in 30% of patients. Conclusions Conversion rates from Ocular to generalized Myasthenia gravis may be lower than previously reported both in immunosuppressed and nonimmunosuppressed patients. A subset of patients may continue to convert to generalized disease beyond 2 years from onset of symptoms, and close monitoring should be continued.
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Medical treatment options for Ocular Myasthenia gravis.
Current opinion in ophthalmology, 2008Co-Authors: Aileen Antonio-santos, Eric EggenbergerAbstract:Purpose of reviewTo update our current concepts of Ocular Myasthenia gravis medical management and to provide a short overview of upcoming treatments.Recent findingsCholinesterase inhibitors and corticosteroids have been the first-line treatment for Ocular Myasthenia gravis. Several studies on other
Michael Benatar - One of the best experts on this subject based on the ideXlab platform.
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Ocular Myasthenia.
Neurologic clinics, 2018Co-Authors: Mohammed Al-haidar, Michael Benatar, Henry J KaminskiAbstract:Ocular Myasthenia is a form of Myasthenia gravis in which weakness is restricted to the Ocular muscles and may produce significant visual disability. Patients present with fluctuating ptosis, diplopia, or a combination of both. Examination may show any type of Ocular motility deficit ranging from isolated muscle palsy to complete ophthalmoplegia. Cogan lid twitch, enhanced ptosis, peek sign, and saccadic fatigue are specific examination findings that support the clinical diagnosis of Myasthenia gravis. Confirmation of the diagnosis is challenging with autoantibody serology, and repetitive nerve stimulation studies are often negative.
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Design of the Efficacy of Prednisone in the Treatment of Ocular Myasthenia (EPITOME) trial
Annals of the New York Academy of Sciences, 2012Co-Authors: Michael Benatar, Donald B. Sanders, Gil I. Wolfe, Michael P. Mcdermott, Rabi TawilAbstract:Efficacy of Prednisone in the Treatment of Ocular Myasthenia (EPITOME) is a multicenter, randomized, double blind, placebo-controlled trial that is being conducted under the auspices of the Muscle Study Group. EPITOME is the first randomized control trial in patients with Ocular Myasthenia and aims to evaluate the efficacy and tolerability of prednisone over a period of four months in patients with newly diagnosed Ocular Myasthenia whose symptoms have failed to remit in response to a trial of cholinesterase inhibitor therapy.
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medical and surgical treatment for Ocular Myasthenia
Cochrane Database of Systematic Reviews, 2012Co-Authors: Michael Benatar, Henry J KaminskiAbstract:BACKGROUND Approximately 50% of people with Myasthenia gravis present initially with purely Ocular symptoms, so called Ocular Myasthenia and between 50 to 60% of these people will progress to develop generalized disease. The vast majority will do so within the first one to two years. There is controversy surrounding the appropriate management of patients with Ocular Myasthenia. OBJECTIVES To perform a systematic review of the literature relevant to the treatment of Ocular Myasthenia and to answer three specific questions. Are there any medical or surgical treatments that have an impact on the risk of progression from Ocular to generalized Myasthenia gravis? Are there any medical or surgical treatments that improve symptoms of diplopia or ptosis in Ocular Myasthenia? What is the frequency of side effects associated with treatments used in people with Ocular Myasthenia? SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (searched December 2004), MEDLINE (1996 to 2004) and EMBASE (1980 to 2004) for randomized controlled trials as well as case-control and cohort studies. The titles and abstracts of all articles were read by both authors and the full text of all articles that were of possible relevance was reviewed in full. The references of all manuscripts included in the review were scanned to identify additional articles of relevance and experts in the field were contacted to identify additional published and unpublished data. Where necessary and possible, we contacted authors for further information. SELECTION CRITERIA To be included in the review, studies had to meet three criteria: (a) randomized (or quasi-randomized) controlled study design; (b) active treatment compared to placebo, no treatment or some other treatment; and (c) results reported separately for patients with Ocular Myasthenia (grade 1) as defined by the Myasthenia Gravis Foundation of America. DATA COLLECTION AND ANALYSIS We collected data regarding the risk of progression to generalized Myasthenia gravis, improvement in Ocular symptoms, and the frequency of treatment-related side effects. MAIN RESULTS We identified two randomized controlled trials relevant to the treatment of Ocular Myasthenia, only one of which reported results in terms of the pre-specified outcome measures used in this review. This study included only three participants and was of limited methodological quality. In the absence of data from randomized controlled trials, we present a review of the available observational data. AUTHORS' CONCLUSIONS There are no data from randomized controlled trials on the impact of any form of treatment on the risk of progression from Ocular to generalized Myasthenia gravis. The available randomized controlled literature does not permit any meaningful conclusions about the efficacy of any form of treatment for Ocular Myasthenia. Data from several reasonably good quality observational studies suggest that corticosteroids and azathioprine may be beneficial in reducing the risk of progression to generalized Myasthenia gravis.
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The Cochrane Library - Medical and surgical treatment for Ocular Myasthenia
The Cochrane database of systematic reviews, 2012Co-Authors: Michael Benatar, Henry J KaminskiAbstract:BACKGROUND Approximately 50% of people with Myasthenia gravis present initially with purely Ocular symptoms, so called Ocular Myasthenia and between 50 to 60% of these people will progress to develop generalized disease. The vast majority will do so within the first one to two years. There is controversy surrounding the appropriate management of patients with Ocular Myasthenia. OBJECTIVES To perform a systematic review of the literature relevant to the treatment of Ocular Myasthenia and to answer three specific questions. Are there any medical or surgical treatments that have an impact on the risk of progression from Ocular to generalized Myasthenia gravis? Are there any medical or surgical treatments that improve symptoms of diplopia or ptosis in Ocular Myasthenia? What is the frequency of side effects associated with treatments used in people with Ocular Myasthenia? SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (searched December 2004), MEDLINE (1996 to 2004) and EMBASE (1980 to 2004) for randomized controlled trials as well as case-control and cohort studies. The titles and abstracts of all articles were read by both authors and the full text of all articles that were of possible relevance was reviewed in full. The references of all manuscripts included in the review were scanned to identify additional articles of relevance and experts in the field were contacted to identify additional published and unpublished data. Where necessary and possible, we contacted authors for further information. SELECTION CRITERIA To be included in the review, studies had to meet three criteria: (a) randomized (or quasi-randomized) controlled study design; (b) active treatment compared to placebo, no treatment or some other treatment; and (c) results reported separately for patients with Ocular Myasthenia (grade 1) as defined by the Myasthenia Gravis Foundation of America. DATA COLLECTION AND ANALYSIS We collected data regarding the risk of progression to generalized Myasthenia gravis, improvement in Ocular symptoms, and the frequency of treatment-related side effects. MAIN RESULTS We identified two randomized controlled trials relevant to the treatment of Ocular Myasthenia, only one of which reported results in terms of the pre-specified outcome measures used in this review. This study included only three participants and was of limited methodological quality. In the absence of data from randomized controlled trials, we present a review of the available observational data. AUTHORS' CONCLUSIONS There are no data from randomized controlled trials on the impact of any form of treatment on the risk of progression from Ocular to generalized Myasthenia gravis. The available randomized controlled literature does not permit any meaningful conclusions about the efficacy of any form of treatment for Ocular Myasthenia. Data from several reasonably good quality observational studies suggest that corticosteroids and azathioprine may be beneficial in reducing the risk of progression to generalized Myasthenia gravis.
Fanrong Liang - One of the best experts on this subject based on the ideXlab platform.
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Acupuncture for Ocular Myasthenia gravis: A protocol for systematic review and meta-analysis.
Medicine, 2020Co-Authors: Di Zhang, Song Jin, Leixiao Zhang, Lin Chen, Fanrong LiangAbstract:BACKGROUND The aim of this systematic review with meta-analysis is to determine the efficacy and security of acupuncture in treatment of Ocular Myasthenia gravis and find out whether or not the quick short-term efficacy of acupuncture exists. METHODS The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database. All randomized controlled trials on acupuncture for Ocular Myasthenia gravis published in electronic databases from inception to March 1, 2020, with language restricted in Chinese and English will be included in the study.Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the PEDro scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided. RESULTS An evidence of variety of acupuncture treatment methods for treating Ocular Myasthenia gravis will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of effective rate, MGFA PIS, QMG, and MG-composite. Secondary outcomes involve clinical absolute and relative score, titers of AchR antibodies, and the side effects. The treatment frequency and courses will be measured. CONCLUSION This protocol will present the evidence of whether acupuncture is an effective and safe intervention for Ocular Myasthenia gravis. TRIAL REGISTRATION NUMBER CRD42019141325.
Mark J. Kupersmith - One of the best experts on this subject based on the ideXlab platform.
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Should Ocular Myasthenia Gravis Be Treated with Immunomodulation
NEJM Journal Watch, 2007Co-Authors: Mark J. KupersmithAbstract:Whether early treatment with immunomodulating therapy is needed for Ocular Myasthenia gravis (OMG) remains an undecided issue. This comprehensive
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development of generalized disease at 2 years in patients with Ocular Myasthenia gravis
JAMA Neurology, 2003Co-Authors: Mark J. Kupersmith, Robert Latkany, Peter HomelAbstract:Background Generalized Myasthenia gravis will develop in more than 50% of patients who present with Ocular Myasthenia gravis, typically within 2 years. The optimal treatment of Ocular Myasthenia gravis, including the use of corticosteroids, remains controversial. In addition, the prevalence of thymoma and the optimal performance of the edrophonium chloride test for Ocular Myasthenia remain unknown. Objective To assess the effect of oral corticosteroid therapy on the frequency of development of generalized Myasthenia gravis within 2 years, the incidence of thymoma, and the amount of edrophonium needed for a positive test result in patients with Ocular Myasthenia gravis. Methods We reviewed an Ocular Myasthenia gravis database of 147 patients. Patients underwent measurement of acetylcholine receptor (AChR) antibody levels and chest computed tomography. Unless contraindicated, patients with diplopia were recommended for therapy with prednisone, up to 40 to 60 mg/d, with the dosage tapered for 5 to 6 weeks. Most continued to receive daily or alternate-day doses of 2.5 to 10 mg to prevent diplopia. Patients not given prednisone (untreated group) received pyridostigmine bromide or no medication. After the diagnosis, we documented the signs and symptoms of Ocular and generalized Myasthenia gravis and performed 2-year follow-up in 94 patients. Results The mean dose of edrophonium chloride to give a positive response was 3.3 mg (SD, 1.6 mg) for ptosis and 2.6 mg (SD, 1.1 mg) for Ocular motor dysfunction. Thymoma occurred in 1 patient (0.7%). Generalized Myasthenia gravis developed within 2 years in 4 of 58 treated and 13 of 36 untreated patients. The odds ratio (OR) for development of generalized disease in the treated group was 0.13 (95% confidence interval [CI], 0.04-0.45) compared with the untreated group. The AChR antibody level was not predictive of development of generalized Myasthenia gravis at 2 years, but the risk was greater in patients with abnormal AChR antibody levels (OR, 6.33; 95% CI, 1.71-23.42). Logistic regression that included age, abnormal AChR antibody level, and prednisone therapy yielded significance only for abnormal AChR antibody level (OR, 7.03; 95% CI, 1.35-36.64) and treatment (OR, 0.06; 95% CI, 0.01-0.30). Conclusions At 2 years, prednisone treatment appears to reduce the incidence of generalized Myasthenia gravis to 7% in contrast to 36% of patients who did not receive prednisone. Thymoma, although uncommon, occurs in Ocular Myasthenia gravis. Only small amounts of edrophonium are needed to diagnose Ocular Myasthenia gravis.
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Ocular Myasthenia Gravis-Reply
Archives of Neurology, 1997Co-Authors: Mark J. KupersmithAbstract:In reply I thank McQuillen for reminding me of the study report by Mount. 1 This prospective treatment trial using 8 days of corticotropin appeared not to show any benefit on the abnormal Ocular or lid function in patients with Ocular Myasthenia. Despite the fact that it was prospective, there were some significant flaws in the study. Most important was the lack of follow-up of the patients once it was felt that there was no real benefit to the medication. There-fore, patients were not followed up on any regular basis after the first 3 months. The course of medication delivered was brief and of course there were no significant side effects. Other problems arose with the fact that although patients had Ocular Myasthenia, there were a number of patients entered who had the illness for a considerable period and had not had generalized Myasthenia. Therefore, one could not extrapolate whether
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Beneficial effects of corticosteroids on Ocular Myasthenia gravis
Archives of neurology, 1996Co-Authors: Mark J. Kupersmith, Mark L. Moster, Sam Bhuiyan, Floyd A. Warren, Harold WeinbergAbstract:Objective: To determine if moderate- or low-dose corticosteroid therapy can reduce the diplopia and frequency of deterioration to generalized disease in Ocular Myasthenia gravis. Design: Retrospective record review. Setting: Two university-based neuro-ophthalmology services. Patients: All 32 patients with Ocular Myasthenia gravis, treated with prednisone, followed up for a minimum of 2 years were included. Patients were treated with 1 or more courses of daily prednisone (highest initial dose, 40-80 mg) gradually withdrawn over 4 to 6 weeks. Subsequently, in 6 patients, 2.5 to 20 mg of prednisone was given on alternate day. Outcome Measures: Diplopia in the primary position or downgaze diplopia and generalized Myasthenia gravis after 2 years of follow-up. Results: Diplopia, which was initially found in the primary position in 29 patients and in the downgaze position in 26 patients, was absent in 21 patients at 2 years. Generalized Myasthenia gravis occurred in 3 patients at 2 years. Elevated serum acetylcholine receptor antibody levels and abnormal electromyography findings were not predictive of worsening. No patient experienced a major steroid complication. Conclusions: Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, can control the diplopia in patients with Ocular Myasthenia gravis. The frequency of deterioration to generalized Myasthenia gravis at 2 years may be reduced; 9.4% in this study compared with more than 40% previously reported frequency. Corticosteroids may be useful even when Ocular motor dysfunction is not normalized.
