EFNS/ENS Guidelines for the treatment of ocular myasthenia

European Journal of Neurology - Tập 21 Số 5 - Trang 687-693 - 2014
Emı́lia Kerty1,2, Ahmed Elsais1,2, Zohar Argov3, Amelia Evoli4, Nils Erik Gilhus5,6
1Department of Neurology, Oslo University Hospital, Oslo, Norway
2Faculty of Medicine, University of Oslo, Oslo, Norway
3Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
4Institute of Neurology, Catholic University, Roma, Italy.
5Department of Clinical Medicine, University of Bergen, Bergen, Norway
6Department of Neurology, Haukeland University Hospital, Bergen, Norway

Tóm tắt

Background and purpose

The symptoms of acquired autoimmune ocular myasthenia are restricted to the extrinsic eye muscles, causing double vision and drooping eyelids. These guidelines are designed to provide advice about best clinical practice based on the current state of clinical and scientific knowledge and the consensus of an expert panel.

Search strategy

Evidence for these guidelines was collected by searches in the MEDLINE and Cochrane databases. The task force working group reviewed evidence from original articles and systematic reviews. The evidence was classified (I, II, III, IV) and consensus recommendation graded (A, B or C) according to the EFNS guidance. Where there was a lack of evidence but clear consensus, good practice points are provided.

Conclusions

The treatment of ocular myasthenia should initially be started with pyridostigmine (good practice point). If this is not successful in relieving symptoms, oral corticosteroids should be used on an alternate‐day regimen (recommendation level C). If steroid treatment does not result in good control of the symptoms or if it is necessary to use high steroid doses, steroid‐sparing treatment with azathioprine should be started (recommendation level C). If ocular myasthenia gravis is associated with thymoma, thymectomy is indicated. Otherwise, the role of thymectomy in ocular myasthenia is controversial. Steroids and thymectomy may modify the course of ocular myasthenia and prevent myasthenia gravis generalization (good practice point).

Từ khóa


Tài liệu tham khảo

10.1111/j.1468-1331.2010.03019.x

10.1111/j.1600-0404.1988.tb06970.x

10.1097/WNO.0b013e3182536558

10.1111/j.1749-6632.1987.tb51317.x

10.1007/s11940-011-0151-8

10.1002/ana.410140504

10.1016/j.ohc.2004.05.014

10.1007/978-1-59745-156-7_6

10.1136/jnnp.48.12.1246

10.1002/ana.410410404

10.1001/archneurol.2012.437

10.1136/jnnp.62.2.156

10.1016/j.jneuroim.2008.05.032

10.1001/archneur.62.6.1002

10.1055/s-2005-858629

10.1001/archneurol.2011.2393

10.1007/s00415-011-6194-7

10.1002/ana.22312

10.1007/s00415-011-6344-y

Benatar M, 2006, Medical and surgical treatment for ocular myasthenia, Cochrane Database Syst Rev, 2, CD005081

10.1017/S0317167100049040

10.1007/BF01215447

10.1055/s-2000-6829

10.1111/j.1468-1331.2004.00867.x

10.1016/S0022-510X(97)00265-7

10.1016/S0039-6257(03)00022-5

10.1001/archneur.60.2.243

10.1177/096368979800700602

10.1007/s00018-005-5390-y

10.1111/j.1399-0039.2006.00599.x

10.1136/bjo.2004.063404

10.1001/archneur.57.5.752

10.1016/j.jns.2003.10.014

10.1001/archneur.57.5.750

10.1001/archneur.1996.00550080128020

10.1007/s004150050059

10.1016/j.ophtha.2007.10.022

10.1212/01.wnl.0000327669.75695.38

10.1007/s00415-009-5120-8

10.1097/00041327-200312000-00002

10.1016/j.jns.2003.08.017

10.1001/archneur.60.10.1491-b

10.1016/S0161-5890(03)00075-0

10.1111/j.1468-1331.2006.01382.x

10.1212/WNL.50.6.1778

10.1111/j.1749-6632.1998.tb11129.x

10.1007/s00415-008-0718-9

10.1196/annals.1254.064

10.1016/S0041-1345(98)00577-6

10.1159/000347068

10.1136/jnnp-2011-300148

10.1186/1471-2377-11-97

10.1212/WNL.55.1.7

10.1016/j.jns.2003.09.016

10.1016/j.athoracsur.2011.08.001

10.1136/jnnp.48.4.332

10.1067/mtc.2001.116191

10.1016/j.jtcvs.2012.12.053

Takanami I, 2009, Therapeutic outcomes in thymectomied patients with myasthenia gravis, Ann Thorac Cardiovasc Surg, 15, 373

10.1097/00002341-200103000-00005

10.1016/S0161-6420(96)30643-X

10.1016/j.clae.2006.03.007

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Thông tin xuất bản

European Journal of Neurology

Tập 21 Số 5

687-693

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