Nizar Souayah, MD, explains why the concept of “control” in MG can be misleading when assessing treatment success.
Transcript
The word control is, in my opinion, sometimes dangerous. Because it puts everybody as the same. The doctor, the patient, and the insurance — of course, even the insurance.
The first thing to get overlooked is the residual symptoms. The patients up in crisis. He’s up in the hospital. He can do some of his activity. But, again, cannot eat solid food.
Cannot go out beyond 8:00 because he could collapse. Cannot lay flat because he has some short of breath. This is from, basically, the usual symptoms a patient may report.
The second blank spot is the treatment toxicity. Because a patient who is, basically, taking prednisone at high dose may develop diabetes, hypertension, weight gain, psychosis, depression, anxiety, and these are overlooked.
And the third, also thing that is very much overlooked is the patient’s mental health. Because a patient who is living in the, you know, controlled environment, is anxious. And has depression from losing function.
And depression and anxiety may modify the perception of any improvement that you get. So your number could be fine, your activity could be fine, but the patient is feeling miserable.
So because of these overlooked conditions, particularly the mental health, this is chronic autoimmune disease.
