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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 284

Authors’ Reply


Akdeniz University, Medical School, Department of Family Medicine, Antalya

Correspondence Address:
Akdeniz University, Medical School, Department of Family Medicine, Antalya
[email protected]



How to cite this article:
Yaman A, Yaman H. Authors’ Reply . Neurol India 2003;51:284


How to cite this URL:
Yaman A, Yaman H. Authors’ Reply . Neurol India [serial online] 2003 [cited 2023 Jan 29];51:284. Available from: https://www.neurologyindia.com/text.asp?2003/51/2/284/1115


Sir,
We thank for the contribution and comments of the author of the letter written in response to our article “Ocular myasthenia gravis coincident with thyroid ophthalmopathy”.[1] We would like to make some clarifications concerning the points he/she argues.
Firstly, it should be emphasized that, a widespread consensus about the place and long term effects of thymectomy in the treatment of myasthenia gravis, especially in the ocular form, still does not exist; since there is lack of randomised, controlled studies. Although generally thymectomy is not recommended for patients with purely ocular myasthenia, dramatic improvement after thymectomy in several such patients has been observed. So, using this treatment in ocular myasthenia may be considered in certain circumstances, particularly in young patients with relatively recent onset of myasthenia to reduce the possibility that the disease will become generalised and ultimately require long term medications.[2],[3],[4] Moreover, our patient had a suspected thymic mass and a high acetylcholine receptor antibody titer which may be accepted as other indications for thymectomy.[3]
Besides other indications, plasmapheresis is indicated and used as an adjuvant therapy in the preparation of myasthenic patients for thymectomy regardless of the stage and type of the disease, although being more important and beneficial for the severe forms. It has been shown that it reduced the post-operative myasthenic complications, length of hospital stay and cost.[5]
The author states that ptosis is a frequently encountered symptom during the course of thyroid ophthalmopathy citing a study conducted in a very limited number of patients (six out of ten). However, generally accepted knowledge does not confirm this statement. Ptosis in thyroid ophthalmopathy is rare,[6] and should alert the physician to the possibility of myasthenia gravis.[7] Furthermore, besides clinical signs, a high acetylcholine receptor titer and a positive response to neostigmine test were present in our patient, confirming the diagnosis of myasthenia gravis.[1]
 

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1.Yaman A, Yaman H. Ocular myasthenia gravis coincident with thyroid ophthalmopathy. Neurol India 2003;51:100-101.  Back to cited text no. 1    
2.Sanders DB, Howard JF. Disorders of Neuromuscular Transmission.In: Bradley WG, Daroff RB, Fenichel GM, Marsden CD, editors. Neurology in Clinical Practice. 3rd edn. Boston: Butterworth-Heinemann; 2000. Vol II. pp.2167-85.  Back to cited text no. 2    
3.Lucchi M, Mussi A, Ricciardi R, Angeletti CA. Thymectomy in ocular myasthenia gravis (letter). J Thorac Cardiovasc Surg 2003;125:740-1.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Nieto IP, Robledo JP, Pajuelo MC, Montes JA, Giron JG, Alonso JG, Sancho LG. Prognostic factors for myasthenia gravis treated by thymectomy: Review of 61 cases. Ann Thorac Surg 1999;67:1568-71.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Seggia JC, Abrev P, Takatani M. Plasmapheresis as preparatory method for thymectomy in myasthenia gravis. Arq Neuropsiquiatr 1995;53:411-5.  Back to cited text no. 5    
6.Glaser JS. Neuro-ophthalmologic examination: General considerations and special techniques. In: Glaser JS, editor. Neuro-ophthalmology. 2nd edn. Philadelphia: JB Lippincott Company; 1990. pp. 37-60.  Back to cited text no. 6    
7.Shaw PJ. Thyroid Disease and the Nervous System. In: Aminoff MJ, editor. Neurology and General Medicine. 3rd edn. New York: Churchill Livingstone; 2001. pp. 317-39.  Back to cited text no. 7    

 

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