Miyastenia Gravis Tarihçesine Yeniden Bir Bakış

deymeer, feza

doi:10.29399/npa.27315

Miyastenia Gravis Tarihçesine Yeniden Bir Bakış

Feza DEYMEER (İstanbul Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)

Nöropsikiyatri Arşivi

42 1

Yıl: 2021 Cilt: 58 Sayı: 2 Sayfa Aralığı: 154 - 162 Metin Dili: Türkçe DOI: 10.29399/npa.27315 İndeks Tarihi: 09-11-2021

Miyastenia Gravis Tarihçesine Yeniden Bir Bakış

Öz:

Miyastenia gravis’i (MG) ilk olarak Thomas Willis’in 1672 yılındatarif ettiği düşünülür. MG’ye esas ilgi 19. yüzyılın ortalarından sonrabaşlamış ve 150 yıllık sürede MG hakkında geniş bilgi edinilmiştir.Bu derlemenin amacı, MG tarihçesini belli bir sistematik içindetoparlamak ve İstanbul Üniversitesi deneyimini kısaca aktarmaktır. MGtarihçesi dört döneme ayırarak incelenmiştir: 1868–1930, 1930–1960,1960–1990 ve 1990–2020. İlk dönemde (1868–1930), MG’nin bütünklinik özellikleri tanımlanmıştır. Sinir-kas arasındaki iletimin fizyolojik/farmakolojik özellikleri anlaşılmaya başlanmış, ardışık sinir uyarımınıntemelleri atılmıştır. Kürar zehirlenmesine benzetilen MG’ye toksik birajanın neden olduğu düşüncesi hakim olmuş, MG ile timus ilişkisidikkati çekmeye başlanmıştır. Tedavi ile ilgili kayda değer bir gelişmeolmamıştır. İkinci dönemde (1930–1960), nöromüsküler kavşakta iletiminasetilkolin aracılığıyla olduğu anlaşılmıştır. Ardışık sinir uyarımı MGtanısında kullanılmaya başlanmıştır. MG’nin otoimmun bir hastalıkolabileceği fikri doğmuş, bu amaçla yapılan deneyler sonuç vermeyebaşlamıştır. Bu döneme damgasını vuran antikolinesterazların vetimektominin tedavideki yerini almasıdır. Üçüncü dönemi (1960–1990)MG açısından devrimsel bir dönem olarak kabul etmek mümkündür.Önemli immunolojik mekanizmalar aydınlatılmış (asetilkolin reseptörizolasyonu, anti-asetilkolin reseptör antikoru bulunması) ve MG’ninotoimmun bir hastalık olduğu gösterilmiştir. Tedavinin çehresini tümüyledeğiştiren pozitif basınçlı mekanik ventilasyon ve kortikosteroidlerinyanı sıra plazma değişimi/İVİg ve azatioprin kullanıma girmiştir.Dördüncü dönemde (1990–2020), anti-MuSK antikoru bulunmuş veimmunolojide yeni gelişmeler kaydedilmiştir. Videotorakoskopikyöntemle yapılan timektomi, ameliyatla ilişkili morbidite ve mortaliteninazalmasını sağlamıştır. Yeni ilaçlar kullanıma girmiş ve klinik çalışmalaryapılmaya başlanmıştır. Değerli kılavuzlar hazırlanmıştır. Derlemeninson bölümünde, MG konusunda Türkiye’de öncü olan İstanbulÜniversitesi’nin deneyimi anlatılmıştır.

Anahtar Kelime:

History of Myasthenia Gravis Revisited

Öz:

The first description of myasthenia gravis (MG) was given by Thomas Willis in 1672. MG was the focus of attention after mid-nineteenth century and a great amount of information has been accumulated in a span of 150 years. The aim of this review is to convey this information according to a particular systematic and to briefly relate the experience of Istanbul University. MG history was examined in four periods: 1868- 1930, 1930-1960, 1960-1990, and 1990-2020. In the first period (1868- 1930), all the clinical characteristics of MG were defined. Physiological / pharmacological studies on the transmission at the neuromuscular junction were initiated, and the concept of repetitive nerve stimulation emerged. A toxic agent was believed to be the cause of MG which appeared to resemble curare intoxication. Association of MG with thymus was noticed. No noteworthy progress was made in its treatment. In the second period (1930-1960), acetylcholine was discovered to be the transmitter at the neuromuscular junction. Repetitive nerve stimulation was used as a diagnostic test. The autoimmune nature of MG was suspected and experiments to this end started to give results. The hallmark of this period was the use of anticholinesterases and thymectomy in the treatment of MG. The third period (1960-1990) can probably be considered a revolutionary era for MG. Important immunological mechanisms (acetylcholine receptor isolation, discovery of anti-acetylcholine receptor antibodies) were clarified and the autoimmune nature of MG was demonstrated. Treatment modalities which completely changed the prognosis of MG, including positive pressure mechanic ventilation and corticosteroids as well as plasma exchange/IVIg and azathioprine, were put to use. In the fourth period (1990-2020), more immunological progress, including the discovery of anti-MuSK antibodies, was achieved. Videothoracoscopic thymectomy reduced the morbidity and mortality rate associated with surgery. New drugs emerged and clinical trials were performed. Valuable guidelines were published. In the last part of the review, the experience in MG of Istanbul University, a pioneer in Turkey, is related.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	deymeer f (2021). Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. , 154 - 162. 10.29399/npa.27315
Chicago	deymeer feza Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. (2021): 154 - 162. 10.29399/npa.27315
MLA	deymeer feza Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. , 2021, ss.154 - 162. 10.29399/npa.27315
AMA	deymeer f Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. . 2021; 154 - 162. 10.29399/npa.27315
Vancouver	deymeer f Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. . 2021; 154 - 162. 10.29399/npa.27315
IEEE	deymeer f "Miyastenia Gravis Tarihçesine Yeniden Bir Bakış." , ss.154 - 162, 2021. 10.29399/npa.27315
ISNAD	deymeer, feza. "Miyastenia Gravis Tarihçesine Yeniden Bir Bakış". (2021), 154-162. https://doi.org/10.29399/npa.27315

APA	deymeer f (2021). Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. Nöropsikiyatri Arşivi, 58(2), 154 - 162. 10.29399/npa.27315
Chicago	deymeer feza Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. Nöropsikiyatri Arşivi 58, no.2 (2021): 154 - 162. 10.29399/npa.27315
MLA	deymeer feza Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. Nöropsikiyatri Arşivi, vol.58, no.2, 2021, ss.154 - 162. 10.29399/npa.27315
AMA	deymeer f Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. Nöropsikiyatri Arşivi. 2021; 58(2): 154 - 162. 10.29399/npa.27315
Vancouver	deymeer f Miyastenia Gravis Tarihçesine Yeniden Bir Bakış. Nöropsikiyatri Arşivi. 2021; 58(2): 154 - 162. 10.29399/npa.27315
IEEE	deymeer f "Miyastenia Gravis Tarihçesine Yeniden Bir Bakış." Nöropsikiyatri Arşivi, 58, ss.154 - 162, 2021. 10.29399/npa.27315
ISNAD	deymeer, feza. "Miyastenia Gravis Tarihçesine Yeniden Bir Bakış". Nöropsikiyatri Arşivi 58/2 (2021), 154-162. https://doi.org/10.29399/npa.27315