myasthenia%20gravis
MYASTHENIA GRAVIS
Myasthenia gravis is an autoimmune neurological disorder caused by autoantibodies against the acetylcholine receptor or against a receptor-associated protein, muscle-specific tyrosine kinase (MuSK-Ab).
The autoimmune attack at the muscle endplate leads to failure of neuromuscular transmission and eventually muscle weakness.
In the active phase of the disease, symptoms typically fluctuates and then become severe; myasthenic crisis occur in this phase.
In the stable/inactive phase, symptoms are stable but still persist; it usually worsen attributable to infection, fatigue, tapering of medications or other identifiable factors.
In the burnt-out phase, remission may occur wherein patients are on immunotherapy and symptom-free, or may even be off medications.
In 15-20 years, if the symptoms left untreated, patient's weakness becomes fixed wherein the most severely affected muscles become atrophic.
  1. Benatar M, Kaminski HJ; Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007 Jun;68(24):2144-2149. PMID: 17460154
  2. Chaudhry V, Cornblath DR, Griffin JW, et al. Mycophenolate mofetil: a safe and promising immunosuppressant in neuromuscular diseases. Neurology. 2001 Jan;56(1):94-96. PMID: 11148242
  3. Gajdos P, Chevret S, Toyka K. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev. 2006 Apr(2):CD002277. PMID: 16625559
  4. Chaudhuri A, Behan PO. Myasthenic crisis. QJM. 2009 Feb;102(2):97-107. PMID: 19060020
  5. Ciafaloni E, Massey JM, Tucker-Lipscomb B. Mycophenolate mofetil for myasthenia gravis: an open-label pilot study. Neurology. 2001 Jan;56(1):97-99. PMID: 11148243
  6. Mantageeza R, Bonanno S, Camera G, Antozzi C. Current and emerging therapies for the treatment of myasthenia gravis. Neuropsychiatr Dis Treat. 2011;7:151-160. PMID: 21552317
  7. Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000 Jul;55(1):007-15. PMID: 10891896
  8. Juel VC, Massey JM. Myasthenia gravis. Orphanet J Rare Dis. 2007 Nov;2:44. PMID: 17986328
  9. Hilton-Jones D, Palace J. The management of myasthenia gravis. Practical Neurol. 2005 Feb;5:18-27. http://pn.bmj.com/content/5/1/18.abstract.
  10. Skeie GO, Apostoski S, Evoli A, et al. Guidelines for the treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2006 Jul;13(7):691-699. PMID: 16834699
  11. Schere K, Bedlack RS, Simel DL. Does this patient have myasthenia gravis?. JAMA. 2005 Apr;293(15):1906-1914. PMID: 15840866
  12. Myasthenia Gravis Association. Information About Myasthenia gravis and related disorders. Information Pack. 2005 Apr;5
  13. Vincent A, Palace J, Hilton-Jones D. Myasthenia gravis. Lancet. 2001 Jun;357(9274):2122-2128. PMID: 11445126
  14. Thanvi BR, Lo TC. Update on myasthenia gravis. Postgrad Med J. 2004 Dec;80(950):690-700. PMID: 15579606
  15. Skeie GO, Apostoski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2010 Jul;17(7):893-902. PMID: 20402760
  16. Younger DS, Raksadawan N. Therapy in neuromuscular disease. Neurol Clin. 2001 Feb;19(1):205-215. PMID: 11471765
  17. Myasthenia gravis and other diseases of the neuromuscular junction. Harrison's Online: McGraw-Hill Companies; 2003. http://harrisonsonline.com
  18. Sanders D, Howard J Jr. Disorders of neuromuscular transmission. In: Bradley W, Daroff R, Fenichel G, et al, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia: Butterworth Heinemann Elsevier; 2008
  19. MedWormhttp://www.medworm.com/rss/index.php/Neurology/25/http://www.medworm.com/rss/medicalfeeds/specialities/Neurology.xml
  20. Bird SJ. Clinical manifestations of myasthenia gravis. UpToDate. http://www.uptodate.com/contents/clinical-manifestations-of-myasthenia-gravis. 30 Jun 2011. Accessed 30 May 2012
  21. Bird SJ. Treatment of myasthenia gravis. UpToDate. http://www.uptodate.com/contents/treatment-of-myasthenia-gravis. Aug 2015. Accessed 30 May 2012.
  22. Bird SJ. Diagnosis of myasthenia gravis. UpToDate. http://www.uptodate.com/contents/diagnosis-of-myasthenia-gravis. 07 Apr 2011. Accessed 30 Mar 2012
  23. Gold R, Hohlfeld R, Toyka KV. Progress in the treatment of myasthenia gravis. Ther Adv Neurol Disord. 2008 Sep;1(2):36-51. doi: 10.1177/1756285608093888. PMID: 21180568
  24. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016 Jul;87(4):419-425. doi: 10.1212/WNL.0000000000002790. PMID: 27358333
Editor's Recommendations
Most Read Articles
Audrey Abella, 15 Aug 2018
Supervised aerobic-strength training improved cognitive and motor functions among elderly individuals with mild cognitive impairment (MCI), according to studies presented at AAIC 2018.
12 May 2019
A consistent association exists between perinatal maternal depressive symptoms and child brain development assessed 10 years later, suggests a recent study.
02 Sep 2016
Results of a study show that patients with relapsing-remitting multiple sclerosis may benefit from the new sphingosine 1-phosphate 1 inhibitor drug amiselimod.