Treatment of ocular symptoms in myasthenia gravis

Minal J. Bhanushali, Joanne Wuu, Michael G Benatar

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background: The choice between acetyl-cholinesterase inhibitors (AChE-Is) and steroids as symptomatic therapy for ocular symptoms in myasthenia is controversial. Methods: Thirty-five patients with myasthenia and ocular symptoms were evaluated by a single investigator. The ocular-quantitative myasthenia gravis (QMG) score was determined at each visit. The longitudinal construct validity of the ocular-QMG was assessed. Treatment epochs on AChE-I therapy alone or on steroids were defined for each patient. Changes in ocular-QMG scores between the start and end of each treatment epoch as well as the proportion of subjects achieving remission of symptoms were documented. The frequency of steroid-induced side effects was documented. Results: The longitudinal construct validity was favorable and comparable to that for the total QMG score. Eight patients were treated with AChE-I therapy alone, 6 were initially treated with AChE-I followed by steroids, and 21 received steroids ab initio. There were 14 epochs of AChE-I treatment and 27 epochs of steroid treatment. The mean improvement in ocular-QMG score was greater during the steroid epoch (3.6 ± 2.4) than during the AChE-I epoch (1.1 ± 1.9) (p ≤ 0.0021). Complete resolution of ocular symptoms occurred in 29% of AChE-I treatment epochs and in 70% of steroid treatment epochs. The most common steroid-induced side effects observed were impaired glucose tolerance (67%) and reduced bone mineral density (20%). Conclusion: The ocular-quantitative myasthenia gravis score may be a useful tool for monitoring ocular symptom severity in myasthenia. Steroids appear to be more effective than acetyl-cholinesterase inhibitors. These findings warrant a more formal evaluation in a randomized controlled trial.

Original languageEnglish
Pages (from-to)1335-1341
Number of pages7
JournalNeurology
Volume71
Issue number17
DOIs
StatePublished - Oct 21 2008
Externally publishedYes

Fingerprint

Myasthenia Gravis
Steroids
Therapeutics
Cholinesterase Inhibitors
Glucose Intolerance
Bone Density
Randomized Controlled Trials
Research Personnel

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Treatment of ocular symptoms in myasthenia gravis. / Bhanushali, Minal J.; Wuu, Joanne; Benatar, Michael G.

In: Neurology, Vol. 71, No. 17, 21.10.2008, p. 1335-1341.

Research output: Contribution to journalArticle

Bhanushali, Minal J. ; Wuu, Joanne ; Benatar, Michael G. / Treatment of ocular symptoms in myasthenia gravis. In: Neurology. 2008 ; Vol. 71, No. 17. pp. 1335-1341.
@article{ba7eb5ee50c3489a9af15cafd6c2bf74,
title = "Treatment of ocular symptoms in myasthenia gravis",
abstract = "Background: The choice between acetyl-cholinesterase inhibitors (AChE-Is) and steroids as symptomatic therapy for ocular symptoms in myasthenia is controversial. Methods: Thirty-five patients with myasthenia and ocular symptoms were evaluated by a single investigator. The ocular-quantitative myasthenia gravis (QMG) score was determined at each visit. The longitudinal construct validity of the ocular-QMG was assessed. Treatment epochs on AChE-I therapy alone or on steroids were defined for each patient. Changes in ocular-QMG scores between the start and end of each treatment epoch as well as the proportion of subjects achieving remission of symptoms were documented. The frequency of steroid-induced side effects was documented. Results: The longitudinal construct validity was favorable and comparable to that for the total QMG score. Eight patients were treated with AChE-I therapy alone, 6 were initially treated with AChE-I followed by steroids, and 21 received steroids ab initio. There were 14 epochs of AChE-I treatment and 27 epochs of steroid treatment. The mean improvement in ocular-QMG score was greater during the steroid epoch (3.6 ± 2.4) than during the AChE-I epoch (1.1 ± 1.9) (p ≤ 0.0021). Complete resolution of ocular symptoms occurred in 29{\%} of AChE-I treatment epochs and in 70{\%} of steroid treatment epochs. The most common steroid-induced side effects observed were impaired glucose tolerance (67{\%}) and reduced bone mineral density (20{\%}). Conclusion: The ocular-quantitative myasthenia gravis score may be a useful tool for monitoring ocular symptom severity in myasthenia. Steroids appear to be more effective than acetyl-cholinesterase inhibitors. These findings warrant a more formal evaluation in a randomized controlled trial.",
author = "Bhanushali, {Minal J.} and Joanne Wuu and Benatar, {Michael G}",
year = "2008",
month = "10",
day = "21",
doi = "10.1212/01.wnl.0000327669.75695.38",
language = "English",
volume = "71",
pages = "1335--1341",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "17",

}

TY - JOUR

T1 - Treatment of ocular symptoms in myasthenia gravis

AU - Bhanushali, Minal J.

AU - Wuu, Joanne

AU - Benatar, Michael G

PY - 2008/10/21

Y1 - 2008/10/21

N2 - Background: The choice between acetyl-cholinesterase inhibitors (AChE-Is) and steroids as symptomatic therapy for ocular symptoms in myasthenia is controversial. Methods: Thirty-five patients with myasthenia and ocular symptoms were evaluated by a single investigator. The ocular-quantitative myasthenia gravis (QMG) score was determined at each visit. The longitudinal construct validity of the ocular-QMG was assessed. Treatment epochs on AChE-I therapy alone or on steroids were defined for each patient. Changes in ocular-QMG scores between the start and end of each treatment epoch as well as the proportion of subjects achieving remission of symptoms were documented. The frequency of steroid-induced side effects was documented. Results: The longitudinal construct validity was favorable and comparable to that for the total QMG score. Eight patients were treated with AChE-I therapy alone, 6 were initially treated with AChE-I followed by steroids, and 21 received steroids ab initio. There were 14 epochs of AChE-I treatment and 27 epochs of steroid treatment. The mean improvement in ocular-QMG score was greater during the steroid epoch (3.6 ± 2.4) than during the AChE-I epoch (1.1 ± 1.9) (p ≤ 0.0021). Complete resolution of ocular symptoms occurred in 29% of AChE-I treatment epochs and in 70% of steroid treatment epochs. The most common steroid-induced side effects observed were impaired glucose tolerance (67%) and reduced bone mineral density (20%). Conclusion: The ocular-quantitative myasthenia gravis score may be a useful tool for monitoring ocular symptom severity in myasthenia. Steroids appear to be more effective than acetyl-cholinesterase inhibitors. These findings warrant a more formal evaluation in a randomized controlled trial.

AB - Background: The choice between acetyl-cholinesterase inhibitors (AChE-Is) and steroids as symptomatic therapy for ocular symptoms in myasthenia is controversial. Methods: Thirty-five patients with myasthenia and ocular symptoms were evaluated by a single investigator. The ocular-quantitative myasthenia gravis (QMG) score was determined at each visit. The longitudinal construct validity of the ocular-QMG was assessed. Treatment epochs on AChE-I therapy alone or on steroids were defined for each patient. Changes in ocular-QMG scores between the start and end of each treatment epoch as well as the proportion of subjects achieving remission of symptoms were documented. The frequency of steroid-induced side effects was documented. Results: The longitudinal construct validity was favorable and comparable to that for the total QMG score. Eight patients were treated with AChE-I therapy alone, 6 were initially treated with AChE-I followed by steroids, and 21 received steroids ab initio. There were 14 epochs of AChE-I treatment and 27 epochs of steroid treatment. The mean improvement in ocular-QMG score was greater during the steroid epoch (3.6 ± 2.4) than during the AChE-I epoch (1.1 ± 1.9) (p ≤ 0.0021). Complete resolution of ocular symptoms occurred in 29% of AChE-I treatment epochs and in 70% of steroid treatment epochs. The most common steroid-induced side effects observed were impaired glucose tolerance (67%) and reduced bone mineral density (20%). Conclusion: The ocular-quantitative myasthenia gravis score may be a useful tool for monitoring ocular symptom severity in myasthenia. Steroids appear to be more effective than acetyl-cholinesterase inhibitors. These findings warrant a more formal evaluation in a randomized controlled trial.

UR - http://www.scopus.com/inward/record.url?scp=55449109232&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55449109232&partnerID=8YFLogxK

U2 - 10.1212/01.wnl.0000327669.75695.38

DO - 10.1212/01.wnl.0000327669.75695.38

M3 - Article

C2 - 18936425

AN - SCOPUS:55449109232

VL - 71

SP - 1335

EP - 1341

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 17

ER -