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Unsatisfactory outcomes in myasthenia gravis: influence by care providers

Dunand, Murielle ; Botez, Stephan ; Borruat, François-Xavier ; Roux-Lombard, Pascale ; Spertini, François ; Kuntzer, Thierry

In: Journal of Neurology, 2010, vol. 257, no. 3, p. 338-343

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    Titel
    • Unsatisfactory outcomes in myasthenia gravis: influence by care providers
    Autor
    • Dunand, Murielle. Nerve-Muscle Unit, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011, Lausanne, Switzerland
    • Botez, Stephan. Nerve-Muscle Unit, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011, Lausanne, Switzerland
    • Borruat, François-Xavier. Neuro-Ophtalmology Unit, Jules Gonin Hospital, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
    • Roux-Lombard, Pascale. Immunology and Allergy Service, Geneva University Hospital (HUG), Geneva, Switzerland
    • Spertini, François. Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
    • Kuntzer, Thierry. Nerve-Muscle Unit, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011, Lausanne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Journal of Neurology, 2010, vol. 257, no. 3, p. 338-343. Springer-Verlag
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:317579
    Summary
    Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. ‘Unchanged', ‘worse', ‘exacerbation' and ‘died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P=0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P=0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes