Thank you! This would be good to post under My Groups, Myastenia Gravis links.
Be well,

FANTASTIC article. Makes me hopeful about the prednisone I'm starting today. I copied this to friends and family

This is a good basic paper and well written for understanding what is generally believed about MG. I will link it, but it repeats the shortcomings of most general discussions of MG, the main one relates to statistics and method of diagnosis.

Myasthenia Gravis was a clinical diagnosis until blood tests began to pick up antibodies. If the blood tests have to be positive to diagnose MG, then everyone diagnosed with MG will have positive blood tests. If the muscle studies have to show particular abnormalities to diagnose MG, then everyone diagnosed with MG will have those abnormalities. It makes the doctors more comfortable to have these evidences of their understanding verified, but it does not help any of the patients who do not meet the testing criteria, but have the clinical findings.

We know in contraindication to what was thought a number of years ago, that there are "seronegative" patients with clinical evidence of myasthenia who are antibody positive. For those MuSK positive, their problem is now well described; and although it is a different neuromuscular junction one, because the clinical findings are so close and the historical associations have been MG, it remains under the MG umbrella.

We also know there are other antibodies, for which we have no commercial tests, in patients with symptoms of MG, who respond to treatment for autoimmune problems. This article is relatively dismissive of the clinical validity of those antibodies and certainly a degree of skepticism is a good thing as long as the patients remain diagnosed and treated.

It is of more than academic interest that these misconceptions and prejudices be recognized.

At the very least, editorial boards should insist that statistics in papers reflect the diagnostic skills of the authors. If over 95% of an author's diagnosed patients are seropositive, then one can suspect there is heavy reliance on blood studies for diagnosis and rejection of those who do not meet those criteria. The statistics should read "over 95% of patients we diagnose with MG have positive blood studies" rather than over 95% of patients with MG have positive blood studies.

If patients meet clinical criteria for the diagnosis of MG and a large percentage do NOT have positive serology, then more research needs to be done into their particular autoimmune problems and better testing may become commercially viable. Recognizing the problem will lead to better clinical diagnosis and treatment, and strict diagnostic criteria would permit their inclusion in studies.

For many of us (can you guess I am one :-) ?) this would create a more open and questioning atmosphere as to our understanding of the spectrum of autoimmune myasthenia and the ability and willingness to diagnose and treat "seronegative" autoimmune myasthenia when we see it. b.

Having linked this, I will just add that dismissing a significant portion of a patient population will also affect your treatment statistics which then should read that "for those who meet this criteria, ___% will respond to . . . "

Thank you, act2!
Thank you, b!

THANKS FOR POSTING..........GREAT ARTICLE

Bweeds,
Your comments are important. Maybe you could submit them to the journal as a letter to the editor? There's a six week window to do that.

http://www.ccjm.org/site/misc/instructions_editor_letters.xhtml

I'll check in PubMed to see if the article gets reviewed and will keep you posted.

a2

Thanks for your encouragement and the link. I'll sure give it a try! b.

a well written article. too bad Dr. Kerry Levin didn't actually read it before he insisted I couldn't possibly have seronegative generalized MG and that MG ALWAYS starts in the face. it also didn't stress the importance of doing RNS and SFEMG testing on affected, weakened muscles- normal results from testing unaffected, strong muscles are inconclusive.