Unsatisfactory outcomes in myasthenia gravis: influence by care providers

Article Article scientifique Article Unsatisfactory outcomes in myasthenia gravis: influence by care providers eng 2010 author Dunand Murielle author Botez Stéphan Alcaz 59289 author Borruat Francois-Xavier author Roux-Lombard Pascale 22481 author Spertini Francois author Kuntzer Thierry 338-343 10.1007/s00415-009-5318-9 19760347 0340-5354 http://www.springerlink.com/content/128l911j171n488n/fulltext.pdf Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes. Adolescent Adult Aged Aged, 80 and over Azathioprine/therapeutic use Child Cholinesterase Inhibitors/therapeutic use Clinical Protocols Female Glucocorticoids/therapeutic use Health Personnel/standards/*statistics & numerical data Humans Immunoglobulins, Intravenous/therapeutic use Immunosuppressive Agents/therapeutic use Male Middle Aged Mortality Myasthenia Gravis/*drug therapy/*mortality/surgery Neurology/standards/statistics & numerical data Outcome Assessment (Health Care)/*methods Prednisone/therapeutic use Prospective Studies Pyridostigmine Bromide/therapeutic use Quality of Health Care/standards/*statistics & numerical data Thymectomy/statistics & numerical data Treatment Failure Young Adult Dewey 616 56 Département de médecine 221 false 449 Etude de l'activation des monocytes/macrophages et des polynucléaires neutrophiles 779 Journal of neurology 257 3 8a31b0fd-a9ab-4ce0-8201-659c9ae74a80 Article Restricted file1.pdf 188406 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Unsatisfactory outcomes in myasthenia gravis: influence by care providers	Journal of neurology			2010	625	0

Archive ouverte UNIGE

Botez, Stéphan Alcaz