Ocular myasthenia gravis: updates on an elusive target. Issue 1 (February 2020)

• Record Type: Journal Article
• Authors: Melson, Andrew T.; McClelland, Collin M.; Lee, Michael S.
• Is Part Of: Current opinion in neurology. Volume 33:Issue 1(2020)
• Publication Date: 2020-02
• Subjects: fatigable ptosis -- myasthenia gravis -- ocular myasthenia gravis -- variable diplopia; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.805
• DOI: 10.1097/WCO.0000000000000775
• Languages: English
• ISSNs: 1473-6551

Abstract

Abstract : Purpose of review: Ocular myasthenia gravis (OMG) is a complex condition with heterogenous phenotypes and ill-defined diagnostic criteria. Understanding concomitant risk factors and autoimmune serology can help inform prognosis for generalization and guide treatment. Recent findings: Although antibodies to acetylcholine receptors or muscle-specific kinase likely increase risk of generalization, they are less frequent in OMG. Patients without either antibody tend to have a milder disease process and often have variable antibodies to other end-plate proteins such as LRP4, agrin, or cortactin. The treatment of OMG begins with pyridostigmine and is supplemented by oral prednisone if treatment-resistant or high risk for generalization. Variable oral prednisone regimens have been used with success and further immunosuppression may be best achieved with mycophenolate mofetil and azathioprine. Checkpoint inhibitor-induced myasthenia gravis is increasingly recognized and likely has high rates of mortality associated with myocarditis. Summary: Our understanding of OMG and its variable phenotypes continues to evolve. Autoantibody testing increasingly provides valuable diagnostic and prognostic information. Despite these improvements, a lack of quality treatment trials creates significant challenges for evidence-based management guidelines.