Clinical Predictors of Steroid-induced Initial Exacerbation in Myasthenia Gravis

J Korean Neurol Assoc > Volume 23(4); 2005 > Article

Journal of the Korean Neurological Association 2005;23(4): 478-483.

스테로이드 투여 초기에 발생하는 중증근무력증 증상 악화의 임상적 예측 인자

배종석, 김병준a 김대현b

서울의료원 신경과, 성균관대학교 의과대학 삼성서울병원 신경과a, 충남대학교 의과대학 신경과학교실b

Clinical Predictors of Steroid-induced Initial Exacerbation in Myasthenia Gravis

Jong-Seok Bae

Department of Neurology, Seoul Medical Center, Seoul; Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Centera, Seoul; Department of Neuology, Chungnam National University College of Medicineb, Daejeon, Korea

Abstract

Background: The use of prednisone in the treatment of myasthenia gravis (MG) has been required circumspection because of its tendency to produce exacerbations of weakness in the early stages of treatment, often requiring critical management. However, factors influencing the exacerbation has not been defined well. The purpose of this study was to evaluate the clinical factors predicting the exacerbation by prednisone in the early stage of treatment in MG.
Methods: Fifty five patients, first-ever prescribed high dose prednsone (40-80 mg) during hospitalization in Samsung Medical Center were included. Prednisone induced exacerbation was defined as significant exacerbation of objective neurologic signs of MG within 4 weeks after prednisone addition by utilizing Myasthnia gravis Severity Scale (MSS). We investigate the differences between the exacerbated and nonexacerbated groups in the clinical, laboratory and electrophysiological features.
Results: Twenty three patients (42%) experienced definite exacerbation after prednisone treatment. Old age, presence of bulbar symptom, and severe neurologic finding reflected by MSS score were significant predictors of prednisone induced exacerbation in multivariate logistic regression analysis. Higher prednisone dosage per body weight (Kg) was neither a significant predictor of exacerbation nor related with the early improvement in bivariate correlation.
Conclusions: Prednisone induced exacerbation in MG is a frequent challenging problem to clinician. Clinicans should keep in mind the possibility of exacerbation of MG when prescribing prednisone especially, to old, bulbar dominant, severe and disable myasthenic patients.KeyWords:Myasthenia gravis, Steroid, Exacerbation, Predictor