{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:36:32Z","timestamp":1785231392805,"version":"3.55.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2004,9,11]],"date-time":"2004-09-11T00:00:00Z","timestamp":1094860800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Background<\/jats:title>\n                        <jats:p>Myasthenic crisis is the most serious life-threatening event in generalized myasthenia gravis (MG) patients. The objective of this study was to assess the long-term impact of thymectomy on rate and severity of these attacks in Iranian patients.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>We reviewed the clinical records from 272 myasthenic patients diagnosed and treated in our neurology clinic during 1985 to 2002. Fifty-three patients were excluded because of unconfirmed diagnosis, ocular form of MG, contraindication to surgery, concomitant diseases and loss to follow-up. The Osserman classification was used to assess the initial severity of the disease. Frequency and severity of the attacks were compared between two groups with appropriate statistical tests according to the nature of variables. Multivariate logistic regression analysis was used to assess the predictors of myasthenic crisis in the group of patients without thymoma.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>110 patients were in thymectomy group and the other 109 patients were on medical therapy. These two groups had no significant differences with respect to age at onset, gender, Osserman score in baseline and follow up period. 62 patients (28.3% of all 219 patients) had reported 89 attacks of myasthenic crisis. 20 patients of 62 (32%) were in thymectomy group and 42 (68%) were in the other group. There was significant difference between the two groups in number of patients with crisis (P = 0.001; odds ratio = 2.8 with 95% CI of 1.5 to 5.2). In addition, these attacks were more severe in group of non-thymectomized patients as the duration of ICU admission was longer and they needed more ventilatory support during their attacks. Regression model showed thymectomy and lower age at onset as two predictors of decrement in myasthenic crisis rate in non-thymomatous MG patients.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>It is suggested that frequency and severity of myasthenic attacks as important endpoints in evaluation of MG patients. Thymectomy seems to have a preventive role on rate and severity of these attacks.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/1471-2377-4-12","type":"journal-article","created":{"date-parts":[[2004,9,15]],"date-time":"2004-09-15T08:32:40Z","timestamp":1095237160000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis: A 17-year experience"],"prefix":"10.1186","volume":"4","author":[{"given":"Ali","family":"Soleimani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Moayyeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Akhondzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Sadatsafavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamidreza Tavakoli","family":"Shalmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akbar","family":"Soltanzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2004,9,11]]},"reference":[{"key":"37_CR1","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1056\/NEJM199406233302507","volume":"330","author":"DB Drachman","year":"1994","unstructured":"Drachman DB: Myasthenia gravis. N Engl J Med. 1994, 330: 1797-10.1056\/NEJM199406233302507.","journal-title":"N Engl J Med"},{"issue":"5","key":"37_CR2","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1212\/WNL.48.5.1253","volume":"48","author":"CE Thomas","year":"1997","unstructured":"Thomas CE, Mayer SA, Gungor Y, Swarup R, Webster EA, Chang I, Brannagan TH, Fink ME, Rowland LP: Myasthenic crisis: clinical features, mortality, complications and risk factors for prolonged intubation. Neurology. 1997, 48 (5): 1253-60.","journal-title":"Neurology"},{"issue":"211","key":"37_CR3","first-page":"4220","volume":"107","author":"RS Bedlack","year":"2000","unstructured":"Bedlack RS, Sanders DB: How to handle myasthenic crisis. Essential steps in patient care. Postgrad Med. 2000, 107 (211): 4220-4222.","journal-title":"Postgrad Med"},{"key":"37_CR4","first-page":"379","volume-title":"In Current therapy in neurologic disease","author":"DB Drachman","year":"1993","unstructured":"Drachman DB: Myasthenia gravis. In Current therapy in neurologic disease. Edited by: Johnson RT, Griffin JW. 1993, St. Louis: Mosby-Year Book, 379-84. Fourth","edition":"Fourth"},{"key":"37_CR5","first-page":"153","volume":"10","author":"PA Kirschner","year":"2000","unstructured":"Kirschner PA: The history of surgery of the thymus gland. Chest Surg Clin N Am. 2000, 10: 153-165.","journal-title":"Chest Surg Clin N Am"},{"key":"37_CR6","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/S0003-4975(96)00376-1","volume":"62","author":"A Masaoka","year":"1996","unstructured":"Masaoka A, Yamakawa Y, Niwa H, Fukai I, Kondo S, Kobayashi M, Fujii Y, Monden Y: Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg. 1996, 62: 853-9. 10.1016\/S0003-4975(96)00376-1.","journal-title":"Ann Thorac Surg"},{"key":"37_CR7","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1016\/S0003-4975(98)00184-2","volume":"65","author":"V Bril","year":"1998","unstructured":"Bril V, Kojic J, Ilse WK, Cooper JD: Long-term clinical outcome after transcervical thymectomy for myasthenia gravis. Ann Thorac Surg. 1998, 65: 1520-2. 10.1016\/S0003-4975(98)00184-2.","journal-title":"Ann Thorac Surg"},{"key":"37_CR8","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1016\/S0003-4975(99)00310-0","volume":"67","author":"IP Nieto","year":"1999","unstructured":"Nieto IP, Robledo JP, Pajuelo MC, Montes JA, Giron JG, Alonso JG, Sancho LG: Prognostic factors for myasthenia gravis treated by thymectomy: review of 61 cases. Ann Thorac Surg. 1999, 67: 1568-71. 10.1016\/S0003-4975(99)00310-0.","journal-title":"Ann Thorac Surg"},{"key":"37_CR9","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/00000658-199709000-00012","volume":"226","author":"GB Bulkley","year":"1997","unstructured":"Bulkley GB, Bass KN, Stephenson GR, Diener-West M, George S, Reilly PA, Baker RR, Drachman DB: Extended cervico-mediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg. 1997, 226: 324-34. 10.1097\/00000658-199709000-00012. discussion 334-5","journal-title":"Ann Surg"},{"key":"37_CR10","first-page":"337","volume":"11","author":"A Baraka","year":"2001","unstructured":"Baraka A: Anesthesia and critical care of thymectomy for myasthenia gravis. Chest Surg Clin N Am. 2001, 11: 337-61.","journal-title":"Chest Surg Clin N Am"},{"key":"37_CR11","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1111\/j.1749-6632.1966.tb45497.x","volume":"135","author":"B Castleman","year":"1966","unstructured":"Castleman B: The pathology of the thymus gland in myasthenia gravis. Ann N Y Acad Sci. 1966, 135: 496-505.","journal-title":"Ann N Y Acad Sci"},{"key":"37_CR12","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1212\/WNL.40.12.1828","volume":"40","author":"DJ Lanska","year":"1990","unstructured":"Lanska DJ: Indications for thymectomy in myasthenia gravis. Neurology. 1990, 40: 1828-9.","journal-title":"Neurology"},{"key":"37_CR13","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/S0003-4975(00)01595-2","volume":"70","author":"GS Gronseth","year":"2000","unstructured":"Gronseth GS, Barohn RJ: Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Ann Thorac Surg. 2000, 70: 327-34. 10.1016\/S0003-4975(00)01595-2.","journal-title":"Ann Thorac Surg"},{"key":"37_CR14","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/j.1749-6632.1987.tb51329.x","volume":"505","author":"LP Rowland","year":"1987","unstructured":"Rowland LP: General discussion on therapy in myasthenia gravis. Ann N Y Acad Sci. 1987, 505: 607-609.","journal-title":"Ann N Y Acad Sci"},{"key":"37_CR15","unstructured":"Allan W: Treatment of myasthenia gravis-II. UpToDate. Version 10.2."},{"key":"37_CR16","first-page":"497","volume":"38","author":"KE Osserman","year":"1971","unstructured":"Osserman KE, Genkins G: Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. M Sinai J Med. 1971, 38: 497-537.","journal-title":"M Sinai J Med"},{"key":"37_CR17","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1111\/j.1749-6632.1981.tb33765.x","volume":"377","author":"MS Cohen","year":"1981","unstructured":"Cohen MS, Younger D: Aspects of the natural history of myasthenia gravis: crisis and death. Ann N Y Acad Sci. 1981, 377: 670-7.","journal-title":"Ann N Y Acad Sci"},{"key":"37_CR18","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1046\/j.1468-1331.1998.520137.x","volume":"5","author":"JI O'Riordan","year":"1998","unstructured":"O'Riordan JI, Miller DH, Mottershead JP, Hirsch NP, Howard RS: The management and outcome of patients with myasthenia gravis treated acutely in a neurological intensive care unit. Eur J Neurol. 1998, 5: 137-142. 10.1046\/j.1468-1331.1998.520137.x.","journal-title":"Eur J Neurol"},{"key":"37_CR19","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1159\/000050800","volume":"46","author":"JF Tellez-Zenteno","year":"2001","unstructured":"Tellez-Zenteno JF, Remes-Troche JM, Garcia-Ramos G, Estanol B, Garduno-Espinoza J: Prognostic factors of thymectomy in patients with myasthenia gravis: a cohort of 132 patients. Eur Neurol. 2001, 46: 171-7. 10.1159\/000050800.","journal-title":"Eur Neurol"},{"key":"37_CR20","first-page":"125","volume":"44","author":"K Dural","year":"2003","unstructured":"Dural K, Yildirim E, Han S, Ozisik K, Ulasan N, Saygin H, Sakinci U: The importance of the time interval between diagnosis and operation in myasthenia gravis patients. J Cardiovasc Surg (Torino). 2003, 44: 125-9.","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"37_CR21","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/S1010-7940(99)00052-4","volume":"15","author":"F Venuta","year":"1999","unstructured":"Venuta F, Rendina EA, De Giacomo T, Della Rocca G, Antonini G, Ciccone AM, Ricci C, Coloni GF: Thymectomy for myasthenia gravis: a 27-year experience. Eur J Cardiothorac Surg. 1999, 15: 621-4. 10.1016\/S1010-7940(99)00052-4. discussion 624-5","journal-title":"Eur J Cardiothorac Surg"},{"key":"37_CR22","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s11940-002-0037-x","volume":"4","author":"GS Gronseth","year":"2002","unstructured":"Gronseth GS, Barohn RJ: Thymectomy for Myasthenia Gravis. Curr Treat Options Neurol. 2002, 4: 203-209.","journal-title":"Curr Treat Options Neurol"},{"key":"37_CR23","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1034\/j.1600-0404.2000.00014.x","volume":"101","author":"LC Werneck","year":"2000","unstructured":"Werneck LC, Cunha FM, Scola RH: Myasthenia gravis: a retrospective study comparing thymectomy to conservative treatment. Acta Neurol Scand. 2000, 101: 41-6. 10.1034\/j.1600-0404.2000.00008.x.","journal-title":"Acta Neurol Scand"},{"key":"37_CR24","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1136\/thx.45.5.422","volume":"45","author":"A Mier","year":"1990","unstructured":"Mier A, Laroche C, Green M: Unsuspected myasthenia gravis presenting as respiratory failure. Thorax. 1990, 45: 422-","journal-title":"Thorax"},{"key":"37_CR25","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1378\/chest.97.1.232","volume":"97","author":"KM Dushay","year":"1990","unstructured":"Dushay KM, Zibrack JD, Jensen WA: Myasthenia gravis presenting as isolated respiratory failure. Chest. 1990, 97: 232-","journal-title":"Chest"},{"key":"37_CR26","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1136\/pgmj.74.869.139","volume":"74","author":"JD Urschel","year":"1998","unstructured":"Urschel JD, Grewal RP: Thymectomy for myasthenia gravis. Postgrad Med J. 1998, 74: 139-44.","journal-title":"Postgrad Med J"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-4-12.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2377-4-12\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-4-12","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2377-4-12.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T12:58:47Z","timestamp":1728305927000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/1471-2377-4-12"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,9,11]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2004,12]]}},"alternative-id":["37"],"URL":"https:\/\/doi.org\/10.1186\/1471-2377-4-12","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,9,11]]},"assertion":[{"value":"7 December 2003","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2004","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2004","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"12"}}