第48回日本神経学会総会
＜シンポジウム5-1＞免疫性神経疾患治療のControversy: 1. MG, 2. MS
胸腺摘除の適応とその術前術後対策に関する現在と将来への展望
川口 直樹, 根本 有子, 高橋 宏和, 服部 孝道
千葉大学医学部附属病院神経内科〔〒260-8670 千葉市中央区亥鼻1-8-1〕
A recent evidence-based review failed to show conclusive benefits of thymectomy in non-thymomatous MG patients, and only recommended thymectomy as an option to increase the probability of remission or improvement. Furthermore, it is a matter of another controversy whether thymectomy is beneficial in ocular MG and also late-onset MG patients without thymoma. We reviewed the clinical course and outcomes of ocular MG and late-onset MG patients in a retrospective cross-sectional multi-center survey conducted in Japan. Our data shows that thymectomy may prevent, or limit the severity of, the generalization of the disease but do not improve ocular symptoms. For late-onset MG, thymectomy is a potentially effective treatment. Another problem is that postoperative course can fluctuate and sometimes postoperative respiratory failure and myasthenic crisis may occur. We described that perioperative steroid therapy is feasible and have clinical benefits for generalized MG with fluctuating symptoms. Mainly after thymectomy, tacrolimus or cyclosporine therapy may allow steroid daily doses to be reduced in MG patients who intended to reduce concomitant steroid use.
(臨床神経, 47：872−874, 2007)
key words：重症筋無力症, 胸腺摘除, 高齢発症重症筋無力症, 眼筋型重症筋無力症, 非胸腺腫
（受付日：2007年5月16日）
