Palabras clave
Miastenia Gravis
Enfermedades Neuromusculares
Enfermedades Autoinmunes
Enfermedades Neuromusculares
Enfermedades Autoinmunes
Cómo citar
Gómez, S., Álvarez, Y., & Puerto, J. A. (2013). Miastenia Gravis: una visión actual de la enfermedad. Médicas UIS, 26(3). Recuperado a partir de https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/3917
Resumen
Introducción: la miastenia gravis es una enfermedad autoinmune neuromuscular que afecta la placa motora. Su prevalencia es escasa, siendo mayor en países europeos y Estados Unidos. Pocas revisiones de tema se han publicado en Colombia y Latinoamérica sobre esta enfermedad. Objetivo: presentar una mirada actual y completa de la enfermedad a nivel mundial y de Colombia desde su epidemiologia, etiología, diagnóstico clínico, tratamiento y todo lo que el personal de salud y estudiantes deben saber. Metodología: se realizó una búsqueda en bibliotecas virtuales: Scopus, Google Académico y Medline con palabras claves: miastenia gravis, epidemiologia, Colombia, tratamiento, etiología y diagnóstico. Discusión: su principal característica es la debilidad muscular fuctuante, manifestada como fatiga en el músculo estriado esquelético. Existen varios abordajes para clasifcarla, dependiendo de la edad de comienzo, el resultado de las pruebas serológicas y clínicamente por medio de las clasifcaciones de Osserman y de la Myasthenia Gravis Foundation of America. Los métodos de diagnóstico se aplican dependiendo de las manifestaciones, sin embargo, aún no existe un método con especifcidad del 100%. El tratamiento debe ser individualizado, basado en las características clínicas de cada paciente y dependiente del estadio de la enfermedad. Conclusión: a partir de la mejora en el conocimiento de la fsiopatología de la enfermedad, el diagnóstico y el tratamiento, se ha logrado reducir la mortalidad, así como, su subdiagnóstico, mejorando la calidad de vida de los pacientes y su posterior funcionalidad. (MÉD UIS. 2013;26(3):13-22).
Referencias
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2. Herrera O, Ferrer J, Casares F, Varela A. Miastenia gravis: diagnóstico y tratamiento. AMC. 2009;13(5).
3. Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: past, present, and future. J Clin Invest. 2006;116(11):2843-54.
4. Chaudhuri A, Behan PO. Myasthenic crisis. QJM. 2009;102(2):97-107.
5. Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J. Myasthenia gravis: a review. Autoimmune Dis. 2012;2012:1-10.
6. Juel VC, Massey JM. Myasthenia gravis. Orphanet J Rare Dis. 2007;2:44.
7. Carr AS, Cardwell CR, McCarron PO, McConville J. A systematic review of population based epidemiological studies in Myasthenia Gravis. BMC Neurol. 2010;10:46.
8. Montomoli C, Citterio A, Piccolo G, Cioccale R, Ferretti VV, Fratti C, et al. Epidemiology and geographical variation of myasthenia gravis in the province of Pavia, Italy. Neuroepidemiology. 2012;38(2):100-5.
9. Sánchez JL, Uribe CS, Franco AF, Jiménez ME, Arcos-Burgos OM, Palacio LG. Prevalence of myasthenia gravis in Antioquia, Colombia. Rev Neurol. 2002;34(11):1010-2.
10. Aguilar Ade A, Carvalho AF, Costa CM, Fernandes Jm, D’Almeida JA, Furtado LE, et al. Myasthenia gravis in Ceará, Brazil: clinical and epidemiological aspects. Arq Neuropsiquiatr. 2010;68(6):843-8.
11. Wong V, Hawkins BR, Yu YL. Myasthenia gravis in Hong Kong Chinese. 2. Paediatric disease. Acta Neurol Scand. 1992;86(1):68-72.
12. Murai H, Yamashita N, Watanabe M, Nomura Y, Motomura M, Yoshikawa H, et al. Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey. J Neurol Sci. 2011;305(1-2):97-102.
13. Cetin H, Fülöp G, Zach H, Auff E, Zimprich F. Epidemiology of myasthenia gravis in Austria: rising prevalence in an ageing society. Wien Klin Wochenschr. 2012;124(21-22):763-8.
14. Lai CH, Tseng HF. Nationwide population-based epidemiological study of myasthenia gravis in taiwan. Neuroepidemiology. 2010;35(1):66-71.
15. Oöpik M, Kaasik AE, Jakobsen J. A population based epidemiological study on myasthenia gravis in Estonia. J Neurol Neurosurg Psychiatry. 2003;74(12):1638-43.
16. Vincent A, Clover L, Buckley C, Grimley Evans J, Rothwell PM; UK Myasthenia Gravis Survey. Evidence of underdiagnosis of myasthenia gravis in older people. J Neurol Neurosurg Psychiatry. 2003;74(8):1105-8.
17. Thanvi BR, Lo TC. Update on myasthenia gravis. Postgrad Med J. 2004;80(950):690-700.
18. Thiruppathi M, Rowin J, Li Jiang Q, Sheng JR, Prabhakar BS, Meriggioli MN. Functional defect in regulatory T cells in myasthenia gravis. Ann N Y Acad Sci. 2012;1274:68-76.
19. Guyon T, Levasseur P, Truffault F, Cottin C, Gaud C, Berrih-Aknin S. Regulation of acetylcholine receptor alpha subunit variants in human myasthenia gravis. Quantification of steady-state levels of messenger RNA in muscle biopsy using the polymerase chain reaction. J Clin Invest. 1994;94(1):16-24.
20. Berrih S, Morel E, Gaud C, Raimond F, Le Brigand H, Bach JF. Anti-AChR antibodies, thymic histology, and T cell subsets in myasthenia gravis. Neurology. 1984;34(1):66-71
21. Leprince C, Cohen-Kaminsky S, Berrih-Aknin S, Vernet-Der Garabedian B, Treton D, Galanaud P, et al. Thymic B cells from myasthenia gravis patients are activated B cells. Phenotypic and functional analysis. J Immunol. 1990;145(7):2115-22.
22. Akdis M, Burgler S, Crameri R, Eiwegger T, Fujita H, Gomez E, et al. Interleukins, from 1 to 37, and interferon- γ: receptors, functions, and roles in diseases. J Allergy Clin Immunol. 2011;127(3):701-21. e1-70.
23. Gradolatto A, Nazzal D, Foti M, Bismuth J, Truffault F, Le Panse R, et al. Defects of immunoregulatory mechanisms in myasthenia gravis: role of IL-17. Ann N Y Acad Sci. 2012;1274:40-7.
24. Hori S, Takahashi T, Sakaguchi S. Control of autoimmunity by naturally arising regulatory CD4+ T cells. Adv Immunol. 2003;81:331-71.
25. Battaglia A, Di Schino C, Fattorossi A, Scambia G, Evoli A. Circulating CD4+CD25+ T regulatory and natural killer T cells in patients with myasthenia gravis: a flow cytometry study. J Biol Regul Homeost Agents. 2005;19(1-2):54-62.
26. Zhang Y, Wang HB, Chi LJ, Wang WZ. The role of FoxP3+CD4+CD25hi Tregs in the pathogenesis of myasthenia gravis. Immunol Lett. 2009;122(1):52-7.
27. Hoch W, McConville J, Helms S, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med. 2001;7(3):365-8.
28. Klooster R, Plomp JJ, Huijbers MG, Niks EH, Straasheijm KR, Detmers FJ, et al. Muscle-specific kinase myasthenia gravis IgG4 autoantibodies cause severe neuromuscular junction dysfunction in mice. Brain. 2012;135(Pt 4):1081-101.
29. Vandiedonck C, M Giraud, Garchon HJ. Genetics of autoimmune myasthenia gravis: the multifaceted contribution of the HLA complex. J Autoimmun. 2005;25 Suppl:6-11.
30. Cavalcante P, Cufi P, Mantegazza R, Berrih-Aknin S, Bernasconi P, Le Panse, R. Etiology of myasthenia gravis: innate immunity signature in pathological thymus. Autoimmun Rev. 2013;12(9):863-74.
31. Skeie GO, Pandey JP, Aarli JA, Gilhus NE. TNFA and TNFB polymorphisms in myasthenia gravis. Arch Neurol. 1999;56(4):457-61.
32. Grob D, Arsura EL, Brunner NG, Namba T. The course myasthenia gravis and therapies affecting outcome. Ann N Y Acad Sci. 1987;505:472-99.
33. Juel VC, Massey JM. Autoimmune Myasthenia Gravis: Recommendations for Treatment and Immunologic Modulation. Curr Treat Options Neurol. 2005; 7(1):3-14.
34. Roh HS, Lee SY, Yoon JS. Comparison of clinical manifestations between patients with ocular myasthenia gravis and generalized myasthenia gravis. Korean J Ophthalmol. 2011;25(1):1-7.
35. DiMauro S, Garone C. Myasthenia gravis. 2013.
36. Thomas CE, Mayer SA, Gungor Y, Swarup R, Webster EA, Chang I, et al. Myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation. Neurology. 1997;48:1253-60.
37. Werner P, Kiechl S, Löscher W, Poewe W, Willeit J. Distal myasthenia gravis frequency and clinical course in a large prospective series. Acta Neurol Scand. 2003;108(3):209-11.
38. Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle and Nerve. 2008;37(2):141-9.
39. Mantegazza R, Beghi E, Pareyson D, Antozzi C, Peluchetti D, Sghirlanzoni A, et al. A multicentre follow-up study of 1152 patients with myasthenia gravis in Italy. J Neurol. 1990;237:339-44.
40. Tapias-Vargas L, Tapias-Vargas LF, Tapias L. Miastenia gravis y el timo: pasado, presente y futuro. Rev Colomb Cir. 2009;24(4):269-82.
41. Richman DP, Agius MA. Treatment of autoimmune myasthenia gravis. Neurology. 2003;61(12):1652-61.
42. Ping- Hung K, Pi-Chuan F. Respiratory Care for Myasthenic Crisis. En: Pruitt JA, editores. A look into Myasthenia Gravis. InTech; 2012. p. 55-75.
43. Werneck LC, Scola RH, Germiniani FM, Comerlato EA, Cunha FM. Myasthenic crisis: report of 24 cases. Arq. Neuropsiquiatr. 2002;60(3-A):519-26.
44. Patra S, Singh AP, Srinivas BC, Manjunath CN. Myasthenia crisis following percutaneous coronary intervention in a patient with late onset myasthenia gravis: successful treatment of a unique case. Cardiovasc Interv Ther. 2013;28(3):279-81.
45. Benatar M, Burns T, Swan AV. Serological, pharmacological and electrophysiological tests for the diagnosis of myasthenia gravis. Cochrane Database of Systematic Reviews. 2010(12):1-10.
46. Heldal AT, Eide GE, Gilhus NE, Romi F. Geographical distribution of a seropositive myasthenia gravis population. Muscle Nerve. 2012;45(6):815-9.
47. Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol. 2009;8(5):475-90.
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