Résumé :
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Introduction: in myasthenia gravis (MG), thanks to therapeutic advances, one should aim at a complete or near complete remission within a few months, allowing patients to return to habitual professional and social life. This stage has to be maintained and exacerbations prevented. In daily practice this can be hard to achieve. This difficulty to treat with success some myasthenic patients triggered this study. Objective:. To determine the causes leading to unsatisfactory outcome in a group of recent MG patients. Methods: We randomly included 41 MG patients registered in our neuromuscular database at the Muscle-Nerve Unit, University Hospital, Lausanne, Switzerland. Follow-up was performed either by the myologist which assessed diagnosis or by other neurologists which referred lately the patients to our Nerve-Muscle Unit. Outcome was rated at each consultation according to Myasthenia Gravis Foundation of America Postintervention Status. Complete Stable remission, Pharmacologic Remission, Minimal Manifestations and Improved Status were considered satisfactory outcome. Patients scoring Unchanged (U), Worse (W) or Exacerbated (E) during follow-up were taken into account. Reasons leading to unsatisfactory responsiveness were analysed by Fisher’s exact tests. Results: During follow-up, 54% of patients scored unsatisfactory, related to insufficient medication (36%), infectious diseases (23%) and no compliance (28%). Unsatisfactory outcome rate at the last visit was 19.5%. Unsatisfactory outcome during follow-up was significantly (P=0.004) associated to unsatisfactory outcome at the last visit. Care from the beginning by myologists lead to better outcome, with only 6.7 % of unsatisfactory outcome at the last visit versus 27% in the group followed-up initially by general neurologists. Conclusion: This study points out that 54% of our MG patients had an unsatisfactory outcome during follow-up. Part (60%) of this unsatisfactory outcome could be prevented by tailoring adequate treatments during regular appointments by interested specialists in myology.
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