Ocular myasthenia gravis: Updates on an elusive target

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of reviewOcular 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 findingsAlthough 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.SummaryOur 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.

Original languageEnglish (US)
Pages (from-to)55-61
Number of pages7
JournalCurrent Opinion in Neurology
Volume33
Issue number1
DOIs
StatePublished - Feb 1 2020

Bibliographical note

Funding Information:
This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, NY, NY (ATM).

Keywords

  • fatigable ptosis
  • myasthenia gravis
  • ocular myasthenia gravis
  • variable diplopia

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Review

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