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Thymectomy for nonthymomatous myasthenia gravis:

a propensity score matched study


Pembimbing : dr Theresia Christin, SpS

Penyaji : dr Ida Maya

Background
The efficacy of thymectomy in patients with

non-thymomatous Myasthenia Gravis (MG) is


still unclear.

Objective
Estimate the treatment effect of thymectomy

in achieving remission or minimal


manifestation status in patients with nonthymomatous MG.

Methods
Records from consecutive MG patients who

attended the Neuromuscular Clinic, Toronto


General Hospital,
From January 2000 to August 2013, were

retrospectively reviewed

Methods
The diagnosis of MG was based on
the clinical presentation and
Abnormal antibody status(acetylcholine or
muscle specific kinase)
or single fiber electromyography.

Statistical analyses
Descriptive statistics and missing data
Propensity Score (PS) Models
Matching and Balance of the Covariables
Time-to-event Analyses
Bayesian Models

Result

Result

Result

Result
Figure 2 Relationship between prednisone
treatment duration and dose of prednisone
on the last visit in the matched cohort.
The overall use of prednisone through time
is presented as a ratio of the time under
prednisone in months, over the total followup time, to account for different follow
times. Patients with higher ratios of
prednisone use through time were more
likely to have higher doses at the last visit
(r = 0.5, p < 0.001) for both groups.
There was no significant difference
between groups, although controls tended
to have higher doses of prednisone at the
last visit (p = ns).

Discussion
novel methods to assess the treatment effect

of thymectomy in non-thymomatous
myasthenia gravis.
Bayesian analyses to assess the overall

probability of thymectomy efficacy

Discussion
used 2 approaches to estimate prior
possibilities:
assuming no knowledge (non-informative
prior) and
assuming evidence of no efficacy (skeptical
prior).

Discussion
thymectomy is associated with a high

probability of achieving remission or minimal


manifestation status
thymectomy was also associated with a

higher likelihood of being free from


prednisone through time

Discussion
Propensity scores can only adjust for the

known variables,
as opposed to RCTs were the unknown

variables are assumed to be balanced by the


randomization

Discussion
The retrospective data collection is another

potential source of bias.


There is no different doses prednison through

time, which could influence the outcome

Conclusion
thymectomy is associated with a high

probability of achieving remission or


minimal manifestation status and of being
free from prednisone when compared to
controls

Thank you

Klasifikasi Myasthenia Gravis


- Klasifikasi penyakit Myasthenia Gravis menurut osserman ada 4 tipe
:
1. Okular myasthenia
terkenanya otot-otot mata saja, dengan ptosis dan diplopia sangat
ringan dan tidak ada kematian
2. A. Mild generalized myasthenia
Permulaan lambat, sering terkena otot mata, pelan-pelan meluas ke
otot-otot skelet dan bulber. System pernafasan tidak terkena. Respon
terhadap otot baik.

2. B. Moderate generalized myasthenia


Kelemahan hebat dari otot-otot skelet dan bulbar dan
respon terhadap obat tidak memuaskan.
3. Severe generalized myasthenia
A. Acute fulmating myasthenia
Permulaan cepat, kelemahan hebat dari otot-otot
pernafasan, progesi penyakit biasanya komplit dalam 6
bulan. Respon terhadap obat kurang memuaskan, aktivitas
penderita terbatas dan mortilitas tinggi, insidens tinggi
thymoma

B. Late severe myasthenia


Timbul paling sedikit 2 tahun setelah kelompok I dan II
progresif dari myasthenia gravis dapat pelan-pelan atau
mendadak, prosentase thymoma kedua paling tinggi. Respon
terhadap obat dan prognosis jelek
4. Myasthenia crisis
Menjadi cepat buruknya keadaan penderita myasthenia
gravis dapat disebabkan :
- pekerjaan fisik yang berlebihan
- emosi
- infeksi
- progresif dari penyakit
kerusakan neuro muskuler, misalnya streptomisin, neomisisn,
kurare, kloroform, eter, morfin sedative dan muscle relaxan

patofisiologi

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