Myasthenia gravis; single entity, variable clinical features: Ten years of clinical experience in a tertiary care center ten years clinical experience of a tertiary care center

Introduction: This study is a ten years experience of a tertiary care center documenting the data of 132 myasthenia gravis (MG) patients. Our aim is to review retrospectively the clinical and immunological properties and treatment responses of a heterogeneous group of MG patients. Special attention has been focused on two subgroups, thymoma associated MG and pure ocular MG patients. Methods: Patients evaluated between 2000-2010 and followed at least two years were included. The patients who were followed-up at least 2 years in our clinic between the years of 2000-2010 were included in the study. The demographic properties, course of the disease, immunological parameters, treatment responses were reviewed. The effect of thymectomy has been retrospectively determined by Myasthenia Gravis Foundation of America (MGFA) Postintervention Status. Results: Fifty patients (37.9%) were presented with isolated ocular symptoms and 62% of them were eventually generalized. The mean time to generalization was 12.67±11.9 months. 16.13% were generalized after the second year of disease. It is noteworthy that three patients were generalized 120, 156 and 240 months after the disease onset. In the pure ocular MG subgroup, six (31.6%) patients had thymoma whereas two (10.5%) had thymic hyperplasia. 15.79% of seronegative patients had thymic hyperplasia while 5% (1/19) of them had thymoma. Conclusion: Our findings demonstrate that ocular onset MG patients can develop generalized form in an unexpected time period. The presence of thymoma and thymic hyperplasia in our seronegative and pure ocular MG patients showed the necessity to scan these groups for thymic pathology.