Pitoz: Ne Zaman Oküler Miyastenia Gravis’i Düşündürür?

Öz

Amaç: Oküler miyastenia gravis MG kuvvetsizliğin ekstraoküler kaslar, levator ve orbikularis okuli kasına sınırlı olduğu MG formudur. Oküler MG’nin en sık görülen bulgusu pitozdur. Pitoz şikayetiyle başvuranların ancak %1,6’sı Oküler MG tanısı alır. Çalışmamızın amacı pitoz ile başvuran hangi hastalarda ön planda Oküler MG düşünmek gerektiğini değerlendirmektir.Gereç ve Yöntemler: EMG laboratuarımıza Ocak 2017-Aralık 2018 tarihleri arasında pitoz bulgusu ve Oküler MG ön tanısıyla yönlendirilen hastalar çalışmaya dahil edildi. Katılımcıların demografik özellikleri, pitoz bulgusunun tarafı ya da binoküler olması, bulguya eşlik eden yorgunluk, diplopi, göz sıkma zaafı, asetil kolin reseptör antikor varlığı ile tek lif EMG’de Oküler MG tanısı alma arasındaki ilişki değerlendirildi.Bulgular: Çalışmaya dahil edilen 110 kişinin 14’ü Oküler MG %12,7 , 3’ü jeneralize MG iken 93’ü MG tanısı almadı. Oküler MG tanısı konusunda pozitif prediktif değer PPD ve negatif prediktif değerler NPD sırasıyla: diplopi varlığı için 0,22; 0,9; akşama doğru artan yorgunluk bulgusu için 0,17; 0,18; göz sıkma zaafı varlığı 0,94; 0,98; asetil kolin reseptör antikoru varlığı için 1 ve 0,9 idi. Pitoz bulgusunun tarafı ya da binoküler olması ile OMG tanısı arasında istatistiksel anlamlı ilişki yoktu p=0,133 .Sonuç: Çalışmamızın sonucunda pitoz bulgusuna eşlik eden göz sıkma zaafı Oküler MG tanısı ile yüksek ilişkili bulunmuştur

Anahtar Kelimeler

• Pitoz, Oküler miyastenia gravis, Göz sıkma zaafı, Tek lif EMG

Ptosis: When should Ocular Myasthenia Gravis be Considered?

Abstract

Objective: Ocular myasthenia gravis MG is a form of MG in which the weakness is limited to the extraocular muscles, the levator and orbicularis oculi. The most common finding of Ocular MG is ptosis. Only 1.6% of patients presenting with ptosis are diagnosed with Ocular MG. The aim of our study was to evaluate the patients with ptosis where Ocular MG should be primarily considered.Material and Methods: Patients who were referred to the EMG laboratory between January 2017 and December 2018 with the diagnosis of ptosis and the preliminary diagnosis of Ocular MG were included in the study. The relationship between the demographic characteristics of the participants, the unilateral or bilateral signs of ptosis; the accompanying symptoms of fatigue, diplopia, and eyelid squeezing weakness; the presence of acetylcholine receptor antibodies, and the diagnosis of Ocular MG on single-fiber EMG were evaluated.Results: Of the 110 patients included in the study, 14 were diagnosed with Ocular MG 12.7% and 3 with generalized MG while no MG was found in 93 subjects. The positive predictive value PPD and negative predictive value NPD for the diagnosis of Ocular MG were 0.22 and 0.9 for the presence of diplopia; 0.17 and 0.18 for signs of increased fatigue during the evening; 0.94 and 0.98 for the presence of eyelid squeezing weakness; and 1 and 0.9 for the presence of acetylcholine receptor antibodies, respectively. There was no statistically significant relationship between a diagnosis of unilateral or bilateral ptosis and the presence of Ocular MG p=0.133 .Conclusion: We found eyelid squeezing weakness associated with ptosis to be highly correlated with Ocular MG

Keywords

• Ptosis, Ocular myasthenia gravis, Eyelid squeezing weakness, Single fiber EMG

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