Clinical Spectrum and Therapeutic Outcome of Myasthenia Gravis in a Tertiary Care Hospital: A Retrospective Study.

Abstract

Introduction: Myasthenia gravis (MG) is characterized by defective transmission of electric impulses across the neuromuscular junction. To date, there is a lack of real-world data to understand its management, specifically in the Indian context. To bridge this gap in clinical knowledge, the current study was designed to understand the clinical management of MG in the Indian population.

Materials and methods: This retrospective study included clinical data of MG patients at Madras Medical College, Chennai (2021-2023). Patients were assessed for demographics, clinical characteristics, therapeutic interventions, and clinical outcome. Statistical analysis was performed using GraphPad Prism v.8.0.1.

Results: A total of 49 MG cases were observed, and 14 patients presented with myasthenic crisis (MC). Young onset was observed in 26 cases. Clinical features included ptosis (90%), diplopia (90%), bulbar symptoms (60%), and respiratory illness (19.2%). Bedside tests depicted a decremental response to repetitive nerve stimulation (RNS) (93.8%), acetylcholine receptor (AChR) antibody positivity (45%), and MUSK Ab positivity (3.8%). Treatment comprised intravenous immunoglobulin (IVIG) (10.79%), plasmapheresis (PLEX) for impending crisis or thymoma (3.5%), and combination therapy using acetylcholine esterase inhibitors with immunomodulators (63.26%). Mortality was observed in 4 cases (8.1%), while the remaining 45 MG patients (91.84%) exhibited stable vitals with a median hospital stay of 14 days. Thymectomy had potentially reduced the risk of crisis.

Discussion and conclusion: Early detection of MG can prevent the onset of crisis. Electrophysiological studies were crucial in the diagnosis of atypical cases. Rituximab successfully normalized bulbar and respiratory functions in PLEX/IVIG-resistant patients, enhancing crisis response. Combining AChE inhibitors with immunomodulators ensured good drug compliance and, thereby, reduced the risk of crisis and enabled effective management of MG. Centric studies like this may serve as reference points for designing more extensive studies on MG involving multiple centers nationwide.