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J Neurol. 2016 Apr;263(4):826-34. doi: 10.1007/s00415-015-7963-5. Epub 2015 Dec 24.

Myasthenia gravis: a clinical-immunological update.

Author information

1
Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
2
Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK. jacqueline.palace@ndcn.ox.ac.uk.

Abstract

Myasthenia gravis (MG) is the archetypic disorder of both the neuromuscular junction and autoantibody-mediated disease. In most patients, IgG1-dominant antibodies to acetylcholine receptors cause fatigable weakness of skeletal muscles. In the rest, a variable proportion possesses antibodies to muscle-specific tyrosine kinase while the remainder of seronegative MG is being explained through cell-based assays using a receptor-clustering technique and, to a lesser extent, proposed new antigenic targets. The incidence and prevalence of MG are increasing, particularly in the elderly. New treatments are being developed, and results from the randomised controlled trial of thymectomy in non-thymomatous MG, due for release in early 2016, will be of particular clinical value. To help navigate an evidence base of varying quality, practising clinicians may consult new MG guidelines in the fields of pregnancy, ocular and generalised MG (GMG). This review focuses on updates in epidemiology, immunology, therapeutic and clinical aspects of GMG in adults.

KEYWORDS:

Cell-based assays; IgG4; LRP4; MuSK; Myasthenia gravis; Neuromuscular junction; Thymectomy

PMID:
26705120
PMCID:
PMC4826656
DOI:
10.1007/s00415-015-7963-5
[Indexed for MEDLINE]
Free PMC Article

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