THYMECTOMY IN BLACK-CHILDREN WITH JUVENILE MYASTHENIA-GRAVIS

Fifteen black children with juvenile myasthenia gravis presented to ou r institution over a 10-year period at ages ranging from 18 months to 7 years, 4 males and 11 females. Twelve presented with progressive, ge neralised weakness and 3 had bulbar manifestations. Ocular signs were absent in 2 patients. All 15 patients were placed on pyridostigmine br omide (Mestinon) and 1 also required steroids and plasmapheresis. Medi cal therapy only was instituted in 5 patients, of whom 2 came to surge ry, 2 died, and 1 was lost to follow-up. Thymectomy was performed in 1 2 children (including the 2 with failed medical therapy) via a median sternotomy with no mortality or morbidity related to the operation. Th e timing of surgery was less than 3 months in 75% of the children. Thy mic hyperplasia was noted in 10 glands and 2 were reported as normal. Of the children in the operative group, 83% are on minimal medication or in total remission. Better results were noted in young patients wit h early thymectomy and diseased glands.