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Front. Neurol. | doi: 10.3389/fneur.2018.00077

Clinical characteristics of juvenile myasthenia gravis in southern China.

 Xin Huang1, Yingkai Li1, Huiyu Feng1,  Pei Chen1 and Weibin Liu1*
  • 1Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, China

Objectives: To describe the clinical profile, clinical outcomes and factors that may affect the outcome of juvenile myasthenia gravis (JMG) patients in southern China.
Methods: We reviewed information relating to JMG patients treated and evaluated at the First Affiliated Hospital, Sun Yat-Sen University, between 1998 and 2015. The study involved 327 JMG patients who had been followed up for ≥1 year.
Results: Overall, 77.4% patients showed initial symptoms in the prepubertal period (<12 years). 306 patients showed only ocular symptoms at onset. By the final follow-up, 61 ocular myasthenia gravis (OMG) patients (61/306, 19.9%) had developed generalized myasthenia gravis (GMG). Anti-acetylcholine receptor antibody (AChR-Ab) titer was an independent risk factor for generalization. Eleven patients (3.4%) experienced spontaneous remission, but four relapsed. Low-dose oral prednisone (0.25mg/kg) was administered when symptoms did not significantly improve after pyridostigmine treatment. Immunosuppressants were administered when prednisone was unsatisfactory. Optimal outcome was achieved in 59.6% of patients. Specifically, 60 patients (18.3%) attained complete stable remission (CSR), 12 (3.7%) attained pharmaceutical remission(PR) and 123 (37.6%) attained minimal manifestation(MM). In total, 53 OMG patients (21.5%) attained CSR, a significantly higher proportion than among the GMG patients (8.6%, P=0.009). Moreover, 67.2% of patients with duration <2 years showed significant clinical improvement compared with 46.3% of those with duration >2 years (P<0.001). Thymectomy did not exhibit definite efficacy for JMG patients.
Conclusion: There was a low frequency of cases positive for AChR-Ab in the Chinese population. AChR-Ab titer was revealed as an independent risk factor for generalization. Low doses of prednisone could treat JMG effectively with few side effects.

Keywords: Juvenile myasthenia gravis, Clinical Characteristics, Treatment, outcomes, Southern China

Received: 30 Oct 2017; Accepted: 02 Feb 2018.

Edited by:

Paola Sandroni, Mayo Clinic Minnesota, United States

Reviewed by:

Holli A. Horak, University of Arizona, United States
Julie Khoury, Mayo Clinic Minnesota, United States
Margherita Milone, Mayo Clinic Minnesota, United States  

Copyright: © 2018 Huang, Li, Feng, Chen and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Weibin Liu, First Affiliated Hospital of Sun Yat-sen University, Department of Neurology, Guangzhou, China, neurologymg@163.com