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Home arrow Environment arrow Inflammatory Disorders of the Nervous System: Pathogenesis, Immunology, and Clinical Management
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Surgical Management

Thymectomy Surgical treatment is strongly recommended for patients with thymoma. The clinical efficacy of thymectomy for patients with autoimmune MG without thymoma has been questioned because the evidence supporting its use has not been demonstrated in randomized controlled trials. However, many case reports and series suggest that thymectomy is also of benefit in generalized autoimmune MG, especially when performed in younger patients. The benefit of thymectomy evolves over several years. Thymectomy is advised as soon as the patient’s degree of weakness is sufficiently controlled to permit surgery. Patients undergoing surgery are usually pretreated with low-dose glucocorticoids and IVIg or PE. Thymectomy may not be a viable therapeutic approach for anti-MuSK antibody-positive patients because their thymus glands lack the germinal centers and infiltrates of lymphocytes that characterize thymi in patients who have anti-AChR antibodies. This supports a different pathologic mechanism in anti-MuSK-Ab-positive and anti-AChR-Ab-positive MG [78, 79]. Most experts still consider thymectomy to be a therapeutic option in anti-AChR-Ab-positive generalized MG with disease onset before the age of 50 years [2].

 
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