evidenciar el significativo incremento de la incidencia de miastenia gravis (MG) en la población anciana, así como conocer las particularidades del manejo de esta enfermedad en esos pacientes.
Metodologíaanálisis retrospectivo de los casos de MG en pacientes mayores de 65 años atendidos en el hospital comarcal de la Merced de Osuna, Sevilla, durante los años 1995 a 2003.
Resultadosobtuvimos una serie de 9 pacientes (5 varones y 4 mujeres) con una edad media de 77,6 (± 8,6) años y edad media de inicio de 68,1 (± 13,8) años. El tiempo medio de evolución era de 9,3 (± 11) años. Ocho pacientes (88,8%) presentaron MG de inicio tardío. Clínicamente 7 pacientes (77,7%) presentaron la forma ocular (grupo I) y 2 la generalizada (22,3%), uno leve (grupo IIa) y otro moderada (grupo IIb). Los síntomas oculares fueron las manifestaciones clínicas iniciales preponderantes (88,8%). Sólo uno de los pacientes presentó timoma. Los anticuerpos antirreceptores de acetilcolina (Ac-AchR) fueron positivos en todos los casos. Todos los pacientes recibieron tratamiento con piridostigmina, y en 5 pacientes (55,5%) se usaron además esteroides. No se produjo ninguna muerte, aunque en 3 enfermos (33,3%) los resultados del tratamiento fueron peores.
Conclusioneses necesario cambiar el concepto clásico de MG como patología del adulto joven y considerarla, como refleja nuestro estudio, como una patología emergente en la población anciana. Creemos que la MG es una enfermedad que debemos conocer, dado que la detección y el tratamiento precoces consiguen generalmente una mejoría física y funcional del paciente mayor.
to asses the increased prevalence of myasthenia gravis (MG) among older patients, as well as to determine the particularities of the management of this disease in this age group.
Methodwe performed a retrospective analysis of patients aged more than 65 years with a diagnosis of MG who were treated in a county hospital (Hospital de la Merced, Seville, Spain) between 1995 and 2003.
Resultsnine cases of MG in elderly patients were included. There were 5 men and 4 women. The mean age was 77.6 (± 8.6) years, and the mean age at onset was 68.1 (± 13.8) years. The mean disease duration at enrolment was 9.3 (± 1.3) years. Eight patients (88.8%) were found to have late-onset MG. The predominant clinical forms were ocular (group I) in 7 patients (77.7%) and generalised MG in 2 (22.3%); MG was mild in one (group IIa), and moderately severe in the other (group IIb). The most common symptoms at onset were ocular (88.8%). Thymoma was detected in only one patient. Anti-acetylcholine receptor antibodies were present in all patients. All the patients received pyridostigmine and 5 patients (55.5%) also received steroids. There were no deaths but in 3 patients (33.3%) the outcome of treatment was poor.
Conclusionsthe classical notion that MG affects mainly young adults and is uncommon among the elderly should be modified. The present study shows that MG is an emerging disease among the elderly. We highlight the need for physicians to be well versed in MG since early detention and treatment generally achieve significant clinical and functional improvement in these patients.