Clinical and Neuropsychological Changes and their Impact on Quality of Life of Patients with Myasthenia

The purpose of the study was to examine the quality of life in adult patients with myasthenia in relation to the immunological subtype, clinical form of the disease and neuropsychological status of patients. Materials and methods. Patients underwent clinical and neurological, immunological and quality of life assessments on the MGQoL-15 scale (Myasthenia Gravis Quality of Life-15), Spielberg-Khanin Score and Beck Depression Scale. Data processing was carried out using parametric and nonparametric statistics. 96 patients with myasthenia (56 women and 40 men) were examined (71 – with generalized, 25 – with the ocular form, respectively). Immunological examination included determination of antibodies to acetylcholine receptors and / or muscle-specific tyrosine kinase in blood plasma by immunoassay. The average age of patients was 50.5 ± 12.4, the mean duration of the disease was 4.4 ± 1.2 years. Results and discussion. When analyzing the duration of the disease, we detected 2 peaks: the early (the first manifestations of the disease under the age of 40) – 49 patients and the late (the first manifestations of the disease at the age of 60) – 47 patients. Antibodies to acetylcholine receptors were detected in 57 (80.3%) of the 71 patients with generalized form and in 13 (52%) of the 25 patients with ocular form of myasthenia. Antibodies to muscle specific tyrosine kinase were detected in 6 (8.5%) of the 71 patients with generalized myasthenia. In cases with the ocular form, these antibodies were not detected. In 8 (11.3%) out of the 71 patients with generalized form of myasthenia and 12 (48.0%) out of the 25 patients with the ocular form of myasthenia neither antibodies to acetylcholine receptors, nor antibodies to muscle specific tyrosine kinase were detected (seronegative type of myasthenia). When evaluated on the MGQoL-15 scale, the average quality of life of patients with myasthenia was 10.34 ± 9.4 points (ranging from 0 to 31). In patients with ocular myasthenia (Class I MGFA), the quality of life was significantly higher in comparison to patients with generalized form (p <0.05). With generalized form, quality of life indicators decreased whereas the severity of the disease increased (Class III and IV MGFA). The level of life quality does not depend on the detection of antibodies to acetylcholine receptors, antibodies to muscle-specific tyrosine kinases or their absence (p> 0.05). In the assessment of situational anxiety on the Spielberg-Khanin scale, a moderate level of anxiety was detected in 44 patients, a high level – in 24 patients, while 28 people had a low level of anxiety. In patients with the ocular form of myasthenia (Class I MGFA) significantly more often a low level of anxiety (p <0.05) was recorded. With the generalized form, a low level of situational anxiety was significantly more frequently recorded in patients with class II MGFA myasthenia (mild form). A moderate level of situational anxiety was significantly more frequently recorded in patients with myasthenia class III MGFA (moderate form), and a high level – in patients with myasthenia class IV MGFA (severe form). When comparing the quality of life in patients with myasthenia on the MGQoL-15 scale with the level of situational anxiety on the Spielberg-Khanin scale, there was a certain (although not strong) impact of anxiety level on the quality of life of patients (r = -0.26, p = 0.007 ). Depressive manifestations of mild (32 persons) and moderate (34 persons) forms of depression were detected in 66 patients, the mean score on the Beck scale was 12.9 ± 3.45 points).