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September 2016

Seronegative Myasthenia Gravis—A Vanishing Disorder?

Author Affiliations
  • 1Department of Neurology, George Washington University, Washington, DC
  • 2Department of Pharmacology and Physiology, George Washington University, Washington, DC
JAMA Neurol. 2016;73(9):1055-1056. doi:10.1001/jamaneurol.2016.2277

With the initial identification in 1976 of antibodies directed toward the acetylcholine receptor (AChR) in the serum of patients with myasthenia gravis (MG),1 it became clear that upwards of 20% of patients with clinical and electrophysiological evidence of a neuromuscular disorder lacked such antibodies. Was this because of the presence of low-affinity antibodies that were capable of disease induction but not detectable by the standard radioimmunoassay? This answer appears to be partially the case. Using cell-based assays that present the complex pentameric, membrane-bound AChR in a much more native state, AChR antibodies can be found among seronegative patients.2 However, Lindstrom et al1 suggested another possibility that antibodies may be directed toward other target antigens and produce a similar clinical and electrophysiological disorder.

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