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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.33 no.1 São Paulo Mar. 1975

http://dx.doi.org/10.1590/S0004-282X1975000100004 

Corticosteroides no tratamento da miastenia grave. Estudo de 12 casos com revisão da literatura

 

Corticosteroids in the management of myasthenia gravis

 

 

José Lamartine de Assis

Professor Adjunto de Clínica Neurológica do Departamento de Neuropsiquiatria da Faculdade de Medicina da Universidade de São Paulo

 

 


RESUMO

Foram estudados os resultados do tratamento da miastenia grave em 12 pacientes, sendo 10 com a forma generalizada severa, um com a forma generalizada moderada e um com miastenia acentuada associada a polimiosite. Sete pacientes foram previamente timectomizados e somente um apresentava timoma. Todos estavam em uso de doses elevadas de drogas anticolinesterásicas com resposta terapêutica pobre ou nula. Um paciente foi tratado com dexametaxona, outro com dexametazona seguida de prednisona e os restantes com prednisona, sempre em doses altas inicialmente (100 mg por dia ou em dias alternados) e com redução gradativa ulterior até doses de manutenção. Os corticosteróides foram administrados sempre pela via oral, por períodos que variaram de duas semanas até dois anos e meio.
Em conclusão, 75% de 12 pacientes com miastenia grave generalizada foram influenciados favoravelmente com este método terapêutico. Deste grupo apenas um apresentava timoma e não respondeu a qualquer tratamento. Outro paciente apresentava polimiosite associada e teve excelente resposta terapêutica. Dois miastênicos sem timoma tiveram a sintomatologia exacerbada durante o tratamento. Nenhum efeito colateral importante foi observado, mesmo nos pacientes tratados a longo prazo.


SUMMARY

The results of treatment of myasthenia gravis in 12 patients are reported. There were 10 cases with severe generalized form and two cases with moderate generalized form, one of which associated with polymyositis. Seven patients had prior thymectomy and one of them had a thymoma. All the patients were receiving anticholinesterase drugs with poor response or without any response. One patient received a short, intensive course of dexametazone, and other patient used prednisone after a more prolonged dexametazone course. The remaining patients received prednisone, always beginning with high (100 mg) alternate day oral single-doses. This therapy has been maintained for a period thought to be sufficient to suppress the symptoms, as well as to allow remission or an improvement for remaining even when prednisone had been slowly decreased, after a scheduled of one to two years of treatment.
In conclusion, 75% of 12 patients with generalized myasthenia gravis showed improvement or complete remission of symptoms during the corticosteroid therapy. There was only a case with thymoma that showed no response to all treatments. Other patient had a polymyositis associated with myasthenia gravis and showed an excellent therapeutic result. Two patients without thymoma showed an initial worsening. To date no important side effect was noted including in the patients treated for a long period.


 

 

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