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Page 8 of 9 Neuroimmunol Neuroinflammation 2018;5:37 I http://dx.doi.org/10.20517/2347-8659.2018.45

and psychological disturbance in association with language impairment make it challenging for clinicians
to treat stroke patients. Understanding the problem can lead to early detection and multidisciplinary
intervention, which might be the key to good post-stroke recovery.

11. Decrease in daily dose of mestinon, methylprednisolon and level of depression
affected by self motivation therapy in myasthenia gravis patients

Nieke Indrawati, Retnaningsih, Trianggoro Budisulistyo

Diponegoro University Semarang

[1]
Aim: Myasthenia gravis is an autoimmune disease . One of etiologies of myasthenic crisis is emotional and
[2]
[3]
physical stress . We examined depression levels using the Hamilton Depression Rating Scale and the daily
dose of mestinon and methilprednisolone in myasthenia gravis patients before and after 1 month of self
[4]
motivation therapy.
Methods: Myasthenia gravis patients including 7 males and 18 females at Semarang Myasthenic Society
were measured the level of depression with Hamilton Depression Rating Scale, daily dose of mestinon and
methylprednisolon before and after 1 month self motivation therapy through motivational posters (“Thank
God, I am alive and happy. Physical and emotional stress will only cause relapse of myasthenia, avoid!”)
that were posted in all rooms where patients could read them every day. The relationship between Hamilton
Depression Rating Scale and drug dose were evaluated by using the SPSS 19.0 soft ware. Chi square test was
conducted to evaluate the categorical data. The compatibility of variables to the normal distribution was
reviewed through Shapiro Wilk test. Student’s t test and Wilcoxon test were used to evaluate the parametric
and non para metric data. The signifi cance limit was considered to be P < 0.05.

Results: Hamilton score depression scale before treatment ranged from 9 to 19, average as mild to moderate
depression (13.24 ± 2.17). After being given self motivation therapy for 1 month there was a change in the
hamiltonton depression scale score range from 2 to 9, on average relatively normal (4.84 ± 1.82). There
was no myasthenic crisis that occurred during the 1-month motivation period. There is a change in the
dose of mestinon (60 mg) daily, before therapy 2-4 times a day while post therapy 2-3 times a day, and
methylprednisolone (4 mg) daily, methilprednisolone once a day, while on therapy not used at all. Self
motivational therapy has a significant effect on the Hamilton Depression Rating Scale score, changes in
mestinon and methylprednisolone daily dose with P < 0.001. Changes in depression levels affect the daily
dose of mestinon (P = 0.038) but does not affect methylprednisolone (P = 0.371).

Conclusion: Reduced stress levels through self-acceptance and gratitude for life affect the level of depression
and the daily dose of mestinon in myasthenia gravis patients.

REFERENCES
1. Behan WM, Behan PO. Immune complexes in myasthenia gravis. J Neurol Neurosurg Psychiatry 1979;42:595-9.
2. Beydoun SR, Wang J, Levine RL, Farvid A. Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo
cardiomyopathy: a case report. J Med Case Rep 2010;4:393.
3. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-96.
4. Kulaksizoglu IB. Mood and anxiety disorders in patients with myasthenia gravis: aetiology, diagnosis and treatment. CNS Drugs
2007;21:473-81.