The pattern and presentation of myathenia gravis in Al-Shaab and Omdurman Teaching Hospitals

Abstract

Introduction: Myasthenia gravis (MG) is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation.
Objective: to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals, Khartoum Sudan.
Methods: The demographic and clinical characteristics of 50 patients of myasthenia gravis (MG) were reviewed in Alshab and Oumdrman Teaching Hospitals for five months period from May to October 2008.

Results: Out of 2400 patients attending neurology clinics 50 were found to have Myathenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34%. Most of the patients [42%] were from Khartoum State followed by North Kordofan State [14%]. High occurrence of late onset fatigability and weakness was seen in 92 % of our patients. Ocular muscles involvement was detected in 78%. MG was aggravated by hot weather and fever in 12% of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4%. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12% and 4 % respectively. The diagnosis was made by classic history and neurological examinations in 88% and positive neostigmin test in64%. The majority of patients were treated with steroids. Thymectomy was done in 10% patients. The outcome was excellent as 82% improved and only one [2%] patient died.

Discussion: Going with literature diagnosis of MG was made depending on classical history, full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated with
quinine showed deterioration of their symptoms in our study. Strikingly, myasthenia crisis which were reported in 27% of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96%] of our patients were treated with steroids.
Conclusion: Generalized myasthenia gravis with ocular involvement is common in our patients. However, pure OMG was not seen. Thymectomy was done in a small number of our patients with reference to
other studies.

Keywords: autoimmune, tensilon, neostigmin, thymectomy, diplopia, ptosis.