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Myasthenia Gravis

  • Robert P. Lisak

Abstract

Myasthenia gravis (MG) encompasses several disorders of the neuromuscular junction, characterized by impaired transmission with resulting weakness. The commonest form is an acquired disorder in which there is a decrease in available receptor for acetylcholine at the postjunctional muscle membrane, owing to autoantibodies to portions of that receptor.

Keywords

Acetylcholine Receptor Thymic Cell Peripheral Blood Mononuclear Congenital Myasthenic Syndrome Thymic Lymphocyte 
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References

  1. Aarli JA, Lefvert AK, Tonder O (1981) Thymoma-specific antibodies in sera from patients with myasthenia gravis demonstrated by indirect haemagglutination. J Neuro immunol 1: 421–427Google Scholar
  2. Abramsky O, Aharonov A, Webb C, Fuchs S (1975) Cellular immune response to acetylcholine receptor-rich fraction, in patients with myasthenia gravis. Clin Exp Immunol 19: 11–16PubMedGoogle Scholar
  3. Appel SH, Almon RR, Levy N (1975) Acetylcholine receptor antibodies in myasthenia gravis. N Engl J Med 293: 760–761PubMedCrossRefGoogle Scholar
  4. Appel SH, Anwyl R, McAdams MW, Elias S (1977) Accelerated degradation of acetylcholine receptor from cultured rat myotubes with myasthenia gravis sera and globulins. Proc Natl Acad Sci USA 74: 2130–2134PubMedCrossRefGoogle Scholar
  5. Ashizawa T, Appel SH (1985) Immunopathologic events at the endplate in myasthenia gravis. In: Steck AJ, Lisak RP (Guest Eds) Immunoneurology. Springer Semin Immunopathol8:177–196Google Scholar
  6. Behan PO, Shields J (1982) Genetics. In: Lisak RP, Barchi RL (eds) Myasthenia gravis. Saunders, Philadelphia, pp 37–50Google Scholar
  7. Berrih S, Gaud C, Bach M-A, Le Brigand H, Binet JP, Bach JF (1981) Evaluation of T cell subsets in myasthenia gravis using anti-T cell monoclonal antibodies. Clin Exp Immunol 45: 1–8PubMedGoogle Scholar
  8. Besinger UA, Fateh-Moghadam A, Knorr-Held, Wick M, Kissel H, Albiez M (1987) Immunomodulation in myasthenia gravis by high-dose intravenous 7-5 immunglobulin. Ann NY Acad Sci 505: 828–831CrossRefGoogle Scholar
  9. Bever CT Jr, Aquino AV, Penn AS, Lovelace RE, Rowland LP (1983) Prognosis of ocular myasthenia. Ann Neurol 14: 516–519PubMedCrossRefGoogle Scholar
  10. Birnbaum G, Tsairis P (1976) Suppressor lymphocytes in mayasthenia gravis and effect of adult thymectomy. Ann NY Acad Sci 274: 527–535PubMedCrossRefGoogle Scholar
  11. Bursztajn S, McManaman JL, Elias SB, Appel SH (1983) Myasthenic globulin enhances the los of acetylcholine receptor clusters. Science 219: 195–196PubMedCrossRefGoogle Scholar
  12. Christadoss P, Lennon VA, David C (1979) Genetic control of experimental autoimmune myasthenia gravis in mice. I. Lymphocyte proliferative response to acetylcholine receptor is under //-2-linked Ir gene control. J Immunol 123: 2540–2543PubMedGoogle Scholar
  13. Compston DAS, Vincent A, Newsom-Davis J, Batchelor JR (1980) Clinical, pathological, HLA antigen and immunelogical evidence for disease heterogeneity in myasthenia gravis. Brain 103: 579–601PubMedCrossRefGoogle Scholar
  14. Conomy JP, Levinsohn M, Fanaroff A (1975) Familial infantile myasthenia gravis: a cause of sudden death in young children. J Pediatr 87: 428–430PubMedCrossRefGoogle Scholar
  15. Conti-Tronconi BM, Gotti CM, Hunkapiller MW, Raftery MA (1982) Mammalian muscle acetylcholine receptor: a supramolecular structure formed by four related proteins. Science 218: 1227–1229PubMedCrossRefGoogle Scholar
  16. Devathasan G, Kueh YK, Chong PN (1984) High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 2: 809–810Google Scholar
  17. Donaldson JO (1978) Neurology of pregnancy. Saunders, Philadelphia, pp 62–65Google Scholar
  18. Donaldson JO, Penn AS, Lisak RP, Abramsky O, Brenner T, Schotland DL (1981) Antiacetylcholine receptor antibody in neonatal myasthenia gravis. Am J Dis Child 135: 222–226PubMedGoogle Scholar
  19. Drachman DB (1978) Myastenia gravis. N Engl J Med 298: 136–142; 186–193PubMedCrossRefGoogle Scholar
  20. Drachman DB (1987) Present and future treatment of myasthenia gravis. N Engl J Med 316: 743–745PubMedCrossRefGoogle Scholar
  21. Drachman DB, Angus CW, Adams RN, Michelson JD, Hoffman GJ (1978) Myasthenic antibodies cross-link acetylcholine receptors to accelerate degradation. N Engl J Med 298: 1116–1122PubMedCrossRefGoogle Scholar
  22. Engel AG (1984) Myasthenia gravis and myasthenic syndromes. Ann Neurol 16: 519–534PubMedCrossRefGoogle Scholar
  23. Engel AG, Tsujihata M, Lindstrom JM, Lennon VA (1976) The motor end-plate in myasthenia gravis and in experimental autoimmune myasthenia gravis: a quantitative ultrastructural study. Ann NY Acad Sci 274: 60–79PubMedCrossRefGoogle Scholar
  24. Engel AG, Lambert EH, Gomez MR (1977) A new myasthenic syndrome with end-plate acetylcholinesterase deficiency, small nerve terminals, and reduced acetylcholine release. Ann Neurol 1: 315–330PubMedCrossRefGoogle Scholar
  25. Engel AG, Lambert EH, Mulder DM, Torres CF, Sahashi K, Bertorini TE, Whitaker JN (1979) Investigations of cases of a newly recognized familial, congenital myasthenic syndrome. Ann Neurol 6: 146–147CrossRefGoogle Scholar
  26. Engel AG, Sahashi K, Fumagalli G (1981) The immunopathology of acquired myasthenia gravis. Ann NY Acad Sci377: 158–174Google Scholar
  27. Erulkar SD, Wetzel DM, Kilgren L, Rendt J, Parsons T, Yang S (1984) 5 a-Dihydrotestosterone modulates acetylcholine- activated single channels in myotubes cultured from adult male Xenopus laevis larynx. Neurosci Abst 10: 12Google Scholar
  28. Fateh-Moghadam A, Wick M, Besinger U, Geursen RG (1984) High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 1: 848–849PubMedCrossRefGoogle Scholar
  29. Fenichel GM (1978) Clinical syndromes of myasthenia in infancy and childhood: a review. Arch Neurol 35: 97–103PubMedGoogle Scholar
  30. Fujii Y, Monden Y, Nakahara K, Hashimoto J, Kawashima Y (1984) Antibody to acetylcholine receptor in myasthenia gravis: production by lymphocytes from thymus or thymoma. Neurology 34: 1182–1186PubMedGoogle Scholar
  31. Gajdos PH, Outin H, Elkharrat D, Brunei D, Rohan-Chabot P de, Raphael JC, Goulon-Goeau C, Morel E (1984) High- dose intravenous gammaglobulin for myasthenia gravis. Lancet 1: 406–407PubMedCrossRefGoogle Scholar
  32. Gajdos PH, Outin HD, Morel E, Raphael JC, Goulon M (1987) High-dose intravenous gamma globulin for myasthenia gravis: an alternative to plasma exchange? Ann NY Acad Sci 505: 842–844CrossRefGoogle Scholar
  33. Genkins G, Papatestas AE, Kornfeld P, Horowith SH (1979) Studies in myasthenia gravis: staging and gammaglobulin. In: Dau PC (ed) Plasmapheresis and immunobiology of myasthenia gravis. Houghton Mifflin, Boston, pp 144–150Google Scholar
  34. Gomez CM, Richman DP (1983) Anti-acetylcholine receptor antibodies directed against the a-bungarotoxin binding site induce a unique form of experimental myasthenia. Proc Natl Acad Sci USA 80: 4089–4093PubMedCrossRefGoogle Scholar
  35. Gomez CM, Richman DP, Burres SA, Arnason BGW, Ber- man PW, Fitch FW (1981) Monoclonal hybridoma anti- acetylcholine receptor antibodies: antibody specificity and effect of passive transfer. Ann NY Acad Sci 377: 97–109PubMedCrossRefGoogle Scholar
  36. Goulon M, Elkharrat D, Gajdos PH, Lokiec F, Morel E (1987) Preliminary results in myasthenia gravis treated with cyclosporin. Ann NY Acad Sci 505: 857–860CrossRefGoogle Scholar
  37. Granato DA, Fulpius BW, Moody JF (1976) Experimental myasthenia in Balb/c mice immunized with rat acetylcholine receptor from rat denervated muscle. Proc Natl Acad Sci USA 73: 2872–2876PubMedCrossRefGoogle Scholar
  38. Greer M, Schotland M (1960) Myasthenia gravis in the newborn. Pediatrics 26: 101–108PubMedGoogle Scholar
  39. Haynes BF, Harden EA, Olanow CW, Eisenbarth GS, Weschler AS, Hensley LL, Roses AD (1983) Effect of thymectomy on peripheral lymphocyte subsets in mayasthenia gravis: selective effect on T-cells in patients with thymic atrophy. J Immunol 131: 773–777PubMedGoogle Scholar
  40. Hohlfeld R, Toyka KV, Besinger UA, Gerhold B, Heininger K (1985) Myasthenia gravis: reactivation of clinical disease and of autoimmune factors after discontinuation of long- term azathioprine. Ann Neurol 17: 238–242PubMedCrossRefGoogle Scholar
  41. Hokkanen E (1969) Epidemiology of myasthenia gravis in Finland. J Neurol Sci 9: 463–478PubMedCrossRefGoogle Scholar
  42. Ippoliti G, Cosi V, Piccolo G, Lombardi M, Mantegaz R (1984) High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 2: 809CrossRefGoogle Scholar
  43. Janssen RS, Kaye AD, Lisak RP, Schatz NJ, Arger PA, Savi- no PJ (1983) Radiologic evaluation of the mediastinum in maysthenia gravis. Neurology 33: 534–539PubMedGoogle Scholar
  44. Jenkins RB (1972) Treatment of myasthenia gravis with prednisone. Lancet 1: 765–767PubMedCrossRefGoogle Scholar
  45. Johns TR (1977) Treatment of myasthenia gravis: long-term administration of corticosteroids with remarks on thymectomy. In: Griggs RC, Moxley RT III (eds) Advances in Neurology, vol 17. Raven, New York, pp 99–122Google Scholar
  46. Johns TR (1987) Long-term corticosteroid treatment of myasthenia gravis. Ann NY Acad Sci 505: 568–583PubMedCrossRefGoogle Scholar
  47. Kao I, Drachman DB (1977) Myasthenic immunoglobulin accelerates acetylcholine receptor degradation. Science 196: 527–529PubMedCrossRefGoogle Scholar
  48. Keesey J, Lindstrom J, Cokely H, Herrmann C Jr (1977) Anti-acetylcholine receptor antibody in neonatal myasthenia gravis. N Engl J Med 296: 55PubMedGoogle Scholar
  49. Kornstein MJ, Brooks JJ, Anderson AO, Levinson AI, Lisak RP, Zweiman B (1984) The immunohistology of the thymus in myasthenia gravis. Am J Pathol 117: 184–194PubMedGoogle Scholar
  50. Kurtze JF (1978) Epidemiology of myasthenia gravis. In: Schoenberg BS (ed) Neurological epidemiology: principles and clinical applications. Advances in Neurology, vol 19. Raven, New York, pp 545–564Google Scholar
  51. Lefvert AK, Bergstrom K, Matell G, Osterman PO, Pirskanen R (1978) Determination of acetylcholine receptor antibody in myasthenia gravis: clinical usefulness and pathogenetic implications. J Neurol Neurosurg Psychiat 41: 394–403PubMedCrossRefGoogle Scholar
  52. Lennon VA (1976) Immunology of the acetylcholine receptor. Immunol Commun 5: 323–344PubMedGoogle Scholar
  53. Lennon VA, Lambert EH (1980) Myasthenia gravis induced by monoclonal antibodies to acetylcholine receptors. Nature 285: 238–240PubMedCrossRefGoogle Scholar
  54. Lennon VA, Lambert EH (1981) Monoclonal autoantibodies to acetylcholine receptors: evidence for a dominant idio- type and requirement of complement for pathogenicity. Ann NY Acad Sci 377: 77–95PubMedCrossRefGoogle Scholar
  55. Lennon VA, Lindstrom JM, Seybold ME (1975) Experimental autoimmune myasthenia: a model of myasthenia gravis in rats and guinea pigs. J Exp Med 141: 1365–1375PubMedCrossRefGoogle Scholar
  56. Lennon VA, Lindstrom JM, Seybold ME (1976) Experimental autoimmune myasthenia gravis: cellular and humoral immune responses. Ann NY Acad Sci 274: 283–299PubMedCrossRefGoogle Scholar
  57. Levinson AI, Dziarski A, Lisak RP, Zweiman B, Moskovitz AR, Brenner T, Abramsky O (1981 a) Polyclonal B-cell activity in myasthenia gravis. Neurology 31: 1198–1201Google Scholar
  58. Levinson AI, Dziarski A, Lisak RP, Zweiman B, Moskovitz AR, Brenner T, Abramsky O (1981b) Comparative immunoglobulin synthesis by blood lymphocytes of myasthenics and normals. Ann NY Acad Sci 377: 385–392PubMedCrossRefGoogle Scholar
  59. Levinson AI, Zweiman B, Lisak RP, Dziarski A, Moskovitz AR (1984) Thymic B-cell activation in myasthenia gravis. Neurology 34: 462–468PubMedGoogle Scholar
  60. Levinson AI, Lisak RP, Zweiman B, Kornstein M (1985) Phe- notypic and functional analysis of lymphocytes in myasthenia gravis. In: Steck AJ, Lisak RP (Guest Eds) Immuno- neurology. Springer Semin Immunopathol 8: 209–233Google Scholar
  61. Levinson AI, Zweiman B, Lisak RP (1987 a) Immunopatho- genesis and treatment of myasthenia gravis. J Clin Immunol 7: 187–197Google Scholar
  62. Levinson AI, Zweiman B, Lisak RP (1987 b) Isotype restriction of thymic B-cell immunoglobulin synthesis in myasthenia gravis. Ann NY Acad Sci 505: 701–703Google Scholar
  63. Lindstrom J (1985) Immunobiology of myasthenia gravis, experimental autoimmune myasthenia gravis, and Lambert- Eaton syndrome. Annu Rev Immunol 3: 109–131PubMedCrossRefGoogle Scholar
  64. Lindstrom J, Einarson B (1979) Antigenic modulation and receptor loss in experimental autoimmune myasthenia gravis. Muscle Nerve 2: 173–179PubMedCrossRefGoogle Scholar
  65. Lindstrom JM, Lambert EH (1978) Content of acetylcholine receptor and antibodies bound to receptor in myasthenia gravis, experimental autoimmune myasthenia gravis, and Eaton-Lambert syndrome. Neurology 28: 130–138PubMedGoogle Scholar
  66. Lindstrom JM, Engel AG, Seybold ME, Lennon VA, Lambert EH ( 1976 a) Pathological mechanisms in experimental autoimmune myasthenia gravis. II. Passive transfer of experimental autoimmune myasthenia gravis in rats with anti-acetylcholine receptor antibodies. J Exp Med 144: 739–753Google Scholar
  67. Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD (1976b) Antibody to acetylcholine receptor in myasthenia gravis: prevalence, clinical correlates, and diagnostic value. Neurology 26: 1054–1059PubMedGoogle Scholar
  68. Lindstrom J, Einarson B, Merlie J (1978) Immunization of rats with polypeptide chains from torpedo acetylcholine receptor causes an autoimmune response to receptors in rat muscle. Proc Natl Acad Sci USA 75: 769–773PubMedCrossRefGoogle Scholar
  69. Lisak RP (1984) Plasma exchange in neurologic disease. Arch Neurol 41: 654–657PubMedGoogle Scholar
  70. Lisak RP, Barchi RL (1982) Myasthenia gravis. Saunders, PhiladelphiaGoogle Scholar
  71. Lisak RP, Mercado F, Zweiman B (1979) Cold reactive anti- lymphocyte antibodies in neurological disease. J Neurol Neurosurg Psychiatry 42: 1054–1057PubMedCrossRefGoogle Scholar
  72. Lisak RP, Levinson AI, Zweiman B (1982) Abnormalities of immunologic control mechanisms and autoimmunity in myasthenia gravis. In: Schotland DL (ed) Disorders of the motor unit. Wiley, New York, pp 257–265Google Scholar
  73. Lisak RP, Zweiman B, Skolnik P, Levinson AI, Moskovitz AR, Guerrero F (1983 a) Thymic lymphocyte subpopula- tions in myasthenia gravis. Neurology 33: 868–872Google Scholar
  74. Lisak RP, Laramore C, Zweiman B, Moskovitz A (1983 b) In vitro synthesis of antibodies to acetylcholine receptor by peripheral blood mononuclear cells of patients with myasthenia gravis. Neurology 33: 604–608Google Scholar
  75. Lisak RP, Laramore C, Levinson AI, Zweiman B, Zembryki D, Moskovitz AR (1983 c) In vitro synthesis of antibodies to acetylcholine receptor by thymic lymphocytes from patients with myasthenia gravis. Ann Neurol 14:121Google Scholar
  76. Lisak RP, Laramore C, Levinson AI, Zweiman B, Moskovitz AR, Witte A (1984) In vitro synthesis of antibodies to acetylcholine receptor by peripheral blood cells: role of suppressor T cells in normal subjects. Neurology 34: 802–805PubMedGoogle Scholar
  77. Lisak RP, Levinson AI, Zweiman B, Kornstein M (1985 a) In vitro synthesis of antibodies to acetylcholine receptor (anti- AChR) by thymic lymphocytes (TL) of patients with myasthenia gravis (MG). Neurology 35 [Suppl 1]: 101Google Scholar
  78. Lisak RP, Levinson AI, Zweiman B ( 1985 b) Autoimmune aspects of myasthenia gravis. In: Cruse JM, Lewis RE Jr (eds) Concepts in immunopathol, vol 2, Karger, Basel, pp 65–101Google Scholar
  79. Lisak RP, Laramore C, Levinson AL, Zweiman B, Moskovitz AR (1986 a) Suppressor T cells in myasthenia gravis and antibodies to acetylcholine receptor. Ann Neurol 19: 87–89Google Scholar
  80. Lisak RP, Levinson AI, Zweiman B, Kornstein MJ (1986 b) Antibodies to acetylcholine receptor and tetanus toxoid: in vitro synthesis by thymic lymphocytes. J Immunol 137: 1221–1225Google Scholar
  81. Lisak RP, Levinson AI, Zweiman B, Kornstein MJ (1987) In vitro synthesis of IgG and antibodies to AChR by peripheral and thymic lymphocytes. Ann NY Acad Sci 505: 39–48PubMedCrossRefGoogle Scholar
  82. Matell G, Bergstrom K, Franksson C, Hammarstrom L, Lef- vert AK, Moller E, von Reis G, Smith E (1976) Effects of some immunosuppressive procedures on myasthenia gravis. Ann NY Acad Sci 274: 659–676PubMedCrossRefGoogle Scholar
  83. McLachlan SM, Nicholson LVB, Venables G, Mastaglia FL, Bates D, Smith BR, Hall R (1981) Acetylcholine receptor antibody synthesis in lymphocyte cultures. J Clin Lab Immunol 5: 137–142PubMedGoogle Scholar
  84. McQuillen DP, Koethe SM, McQuillen MP (1983) Cellular response to human acetylcholine receptor in patients with myasthenia gravis. J Neuroimmunol 5: 59–65PubMedCrossRefGoogle Scholar
  85. Mertens HG, Balzereit F, Leipert M (1969) The treatment of severe myasthenia gravis with immunosuppressive agents. Eur Neurol 2: 321–339PubMedCrossRefGoogle Scholar
  86. Mertens HG, Hertel G, Reuther P, Ricker K (1981) Effect of immunosuppressive drugs (azathioprine). Ann NY Acad Sci 377: 691–699PubMedCrossRefGoogle Scholar
  87. Mischak RP, Dau PC, Gonzalez RL, Spitler LE (1979) In vitro testing of suppressor cell activity in myasthenia gravis. In: Dau PC (ed) Plasmapheresis and the immunobiology of myasthenia gravis. Houghton Mifflin, Boston, pp 72–78Google Scholar
  88. Namba T, Brown SB, Grob D (1970) Neonatal myasthenia gravis: report of two cases and review of the literature. Pediatrics 45: 488–504PubMedGoogle Scholar
  89. Newsom-Davis J, Willcox N, Scadding G, Galder L, Vincent A (1981a) Anti-acetylcholine receptor antibody synthesis by cultured lymphocytes in myasthenia gravis: thymic and peripheral blood cell interactions. Ann NY Acad Sci 377: 393–402PubMedCrossRefGoogle Scholar
  90. Newsom-Davis J, Willcox N, Calder L (1981b) Thymus cells in myasthenia gravis selectively enhance production of anti acetylcholine-receptor antibody by autologous blood lymphocytes. N Engl J Med 305: 1313–1318PubMedCrossRefGoogle Scholar
  91. Oosterhuis HJGH (1964) Studies in myasthenia gravis. Part 1. A clinical study of 180 patients. J Neurol Sci 1: 512–546CrossRefGoogle Scholar
  92. Osserman KE (1958) Myasthenia gravis. Grune and Stratton, New York, pp 79–86Google Scholar
  93. Papatestas AE, Genkins G, Horowitz SH, Kornfeld P (1976) Thymectomy in myasthenia gravis: pathologic, clinical, and electrophysiologic correlations. Ann NY Acad Sci 274: 555–573PubMedCrossRefGoogle Scholar
  94. Patrick J, Lindstrom J (1973) Autoimmune response to acetylcholine receptor. Science 180: 871–872PubMedCrossRefGoogle Scholar
  95. Pestronk A, Drachman DB, Self SG (1985) Measurement of junctional acetylcholine receptors in myasthenia gravis: clinical correlates. Muscle Nerve 8: 245–251PubMedCrossRefGoogle Scholar
  96. Richman DP, Patrick J, Arnason BGW (1976) Cellular immunity in myasthenia gravis: response to purified acetylcholine receptor and autologous thymocytes. N Engl J Med 294: 694v698Google Scholar
  97. Sanders DB, Howard JF Jr, Johns TR (1979) Single-fiber electromyography in myasthenia gravis. Neurology 29: 68–76PubMedGoogle Scholar
  98. Schalke B, Kappos L, Dommasch D, Rohrbach E, Mertens HG (1987) Cyclosporin A treatment of myasthenia gravis: initial results of a double-blind trial of cyclosporin A versus azathioprine. Ann NY Acad Sci 505: 872–875CrossRefGoogle Scholar
  99. Schumm F, Wiethólter H, Fateh-Moghadam A, Dichgans J (1985) Thymectomy in myasthenia with pure ocular symptoms. J Neurol Neurosurg Psychiatry 48: 332–337PubMedCrossRefGoogle Scholar
  100. Seybold ME, Drachman DB (1974) Gradually increasing doses of prednisone in myasthenia gravis: reducing the hazards of treatment. N Engl J Med 290: 81–84PubMedCrossRefGoogle Scholar
  101. Sghirlanzone A, Peluchetti D, Mantegazza R, Fiacchino F, Cornelio F (1984) Myasthenia gravis: prolonged treatment with steroids. Neurology 34: 170: 174Google Scholar
  102. Shore A, Limatibul S, Dosch H-M, Gelfand EW (1979) Identification of two serum components regulating the expression of T-lymphocyte function in childhood myasthenia gravis. N Engl J Med 301: 625–629PubMedCrossRefGoogle Scholar
  103. Simpson J A (1981) Myasthenia gravis and myasthenic syndromes. In: Walton JN (ed) Disorders of voluntary muscle, 4th edn. Livingstone, Edingburgh, pp 585–624Google Scholar
  104. Sisley A, Lisak RP, Brenner T (1987) Proliferative response of blood cells of patients with myastenia gravis to purified mammalian acetylcholine receptor. Ann Neurol 22: 139–140Google Scholar
  105. Skolnik PR, Lisak RP, Zweiman B (1982) Monoclonal antibody analysis of blood T-cell subsets in myastenia gravis. Ann Neurol 11: 170–176PubMedCrossRefGoogle Scholar
  106. Snead OC III, Benton JW, Dwyer D, Morley BJ, Kemp GE, Bradley RJ, Oh SJ (1980) Juvenile myasthenia gravis. Neurology 30: 732–739PubMedGoogle Scholar
  107. Stálberg E, Ekstedt J, Broman A (1971) The electromyographic jitter in normal human muscles. Electroencephalogr Clin Neurophysiol 31: 429–438PubMedCrossRefGoogle Scholar
  108. Stauver M, Hudson J, Tindall RSA (1985) Altered thymic cell populations in myasthenia gravis: characterization, localization, and relationship to AChR-bearing cells. Neurology 35 [Suppl 1]: 102Google Scholar
  109. Szobor A (1976) Myasthenia gravis: a quantitative evaluation system: disability status scale (DSS) applied for myasthenia gravis. Eur Neurol 14: 439–446PubMedCrossRefGoogle Scholar
  110. Tarrab-Hazdai R, Aharonov A, Silman I, Fuchs S, Abramsky O (1975 a) Experimental autoimmune myasthenia induced in monkeys by purified acetylcholine receptor. Nature 256: 128–130Google Scholar
  111. Tarrab-Hazdai R, Aharonov A, Abramsky O, Yaar I, Fuchs S (1975 b) Passive transfer of experimental autoimmune myasthenia gravis by lymph node cells in inbred guinea pigs. J Exp Med 142: 785–789Google Scholar
  112. Teg P, Osserman KE (1955) Studies in myasthenia gravis: neonatal and juvenile types. J Mt Sinai Hosp 22: 711–727Google Scholar
  113. Tindall RSA, Rollins JA, Phillips JT, Greenlee RG, Belendiuk G (1987 a) A double-blind randomized placebo-controlled trial to assess the safety and efficacy of cyclosporin A in the treatment of myasthenia gravis. Ann NY Acad Sci 505: 854–856Google Scholar
  114. Tindall RSA, Rollins JA, Phillips JT, Greenlee RG, Wells L, Belendiuk G (1987 b) Preliminary results of a double-blind, randomized, placebo-controlled trial of cyclosporine in myasthenia gravis. N Engl J Med 316: 719–727Google Scholar
  115. Toyka KV, Drachman DB, Pestronk A, Kao I (1975) Myasthenia gravis: passive transfer from man to mouse. Science 190: 397–399PubMedCrossRefGoogle Scholar
  116. Toyka KV, Drachman DB, Griffin DE, Pestronk A, Winkel- stein J A, Fischbeck KH Jr, Kao I (1977) Myasthenia gravis: study of humoral immune mechanisms by passive transfer to mice. N Engl J Med 296: 125–131PubMedCrossRefGoogle Scholar
  117. Tsujihata M, Hazama R, Ishii N, Ide Y, Takamori M (1980) Ultrastructural localization of acetylcholine receptor at the motor endplate: myasthenia gravis and other neuromuscular diseases. Neurology 30: 1203–1211PubMedGoogle Scholar
  118. Tzartos SJ, Lindstrom JM (1980) Monoclonal antibodies used to probe acetylcholine receptor structure: localization of the main immunogenic region and detection of similarities between subunits. Proc Natl Acad Sci USA 77: 755–759PubMedCrossRefGoogle Scholar
  119. Tzartos SJ, Seybold ME, Lindstrom JM (1982) Specificties of antibodies to acetylcholine receptors in sera from myasthenia gravis patients measured by monoclonal antibodies. Proc Natl Acac Sci USA 79: 188–192CrossRefGoogle Scholar
  120. Uchiyama M, Ichikawa Y, Takaya M, Moriuchi J, Shimizu H, Arimari S (1987) High-dose gammaglobulin therapy of generalized myasthenia gravis. Ann NY Acad Sci 505: 868–871CrossRefGoogle Scholar
  121. Vincent A, Newsom-Davis J (1979) Absence of anti-acetyl- choline receptor antibodies in congenital myasthenia gravis. Lancet 1: 441–442PubMedCrossRefGoogle Scholar
  122. Vincent A, Scadding GK, Thomas HC, Newsom-Davis J (1978) In-vitro synthesis of anti-acetylcholine-receptor antibody by thymic lymphocytes in myasthenia gravis. Lancet 1: 305–307PubMedCrossRefGoogle Scholar
  123. Warmolts JR, Engel WK (1972) Benefit from alternate-day prednisone in myasthenia gravis. N Engl J Med 286: 17–20PubMedCrossRefGoogle Scholar
  124. Willcox HNA, Newsom-Davis J, Calder LR (1984) Cell types required for anti-acetylcholine receptor antibody synthesis by cultured thymocytes and blood lymphocytes in myasthenia gravis. Clin Exp Immunol 58: 97–106PubMedGoogle Scholar
  125. Wilson RW, Ward WD, Johns TR (1974) Corticosteroids: a direct effect at the neuromuscular junction. Neurology 24: 1091–1095PubMedGoogle Scholar
  126. Witte A, Cornblath DR, Parry GJ, Lisak RP, Schatz NJ (1984) Azathioprine in the treatment of myasthenia gravis. Ann Neurol 15: 602–605PubMedCrossRefGoogle Scholar
  127. Witte A, Cornblath DR, Lisak RP, Schatz NJ (1986) Monitoring azathioprine therapy in myasthenia gravis. NeurologyGoogle Scholar
  128. Zweiman B, Lisak RP (1986) Cell-mediated immunologic in neurologic diseases. In: Cohen S (ed) Cell-mediated immunity in human disease: Hum Pathol 17: 234–245Google Scholar

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© Springer-Verlag Berlin Heidelberg 1990

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  • Robert P. Lisak

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