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A long term follow up study is presented of 73 patients with myasthenia gravis,living in Amsterdam between 1926 and 1965.In the period 1961-65 the annual incidence was 3.1,the prevalence 53 per million.Maximum severity of the disease occurred during the first seven years after onset in 87%. Eighteen(29%)patients died,of whom eight had a thymoma(TH).Spontaneous improvement or remission occurred at any time during the follow up.At the end of the study(1985)16(22%)patients were in a complete clinical remission,13(18%)had improved considerably(3 with prednisone),12(16%)had improved moderately,12(16%)had remained unchanged and two had deteriorated.If the early deaths are excluded the outcome is similar in the early and the late onset group without TH.Patients with TH had a less favourable course.Associated autoimmune diseases were diagnosed in 25%(n= 58).Because most of these patients were treated with anticholinesterases only,the evolution of their clinical state represents the natural course of MG. |
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