Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of myasthenia gravis in elderly patients: a retrospective study

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Background

The incidence of myasthenia gravis (MG) is increasing, and its characteristics in elderly patients are believed to differ from those in younger patients. However, only a few studies have focused on elderly patients with MG.

Objective

To review the characteristics of MG in elderly patients and evaluate whether older age is an independent factor associated with achieving minimal manifestation status (MMS).

Methods

This retrospective cohort study included 367 patients (319 non-elderly and 48 elderly patients) with MG enrolled at Xiangya Hospital from September 1, 2016, to December 31, 2018. We collected demographic data and information regarding comorbidities, antibody status, Myasthenia Gravis Foundation of America classification, affected muscle groups, thymoma, and treatment. MMS was defined as the primary outcome.

Results

Comorbidities were more common in elderly than in younger patients with MG. Anti-acetylcholine receptor antibody was the dominant subtype, whereas anti-muscle-specific tyrosine kinase antibody was rare and detected only in non-elderly patients. Elderly patients were more likely than younger patients to have generalized MG, but the frequency of thymoma was lower (28.5% vs. 10.4%, p = 0.0078). MMS or better was achieved in 154 (48.3%) and 13 (27.1%) non-elderly and elderly patients, respectively. Older age did not appear to be an independent factor associated with MMS (hazard ratio = 0.625; 95% confidence interval, 0.345–1.131).

Conclusions

Older age was not an independent factor for a worse prognosis in patients with MG. The treatment of elderly patients with MG should be individually tailored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data in this study are available in the supplementary materials.

Code availability

Not applicable.

Abbreviations

MG:

Myasthenia gravis

AChR:

Acetylcholine receptor

MuSK:

Muscle-specific tyrosine kinase

LRP4:

Low-density lipoprotein receptor-related protein 4

MGFA:

Myasthenia Gravis Foundation of America

MMS:

Minimal manifestation status

IVIG:

Intravenous immunoglobulin

PE:

Plasma exchange

References

  1. Gilhus NE (2012) Myasthenia and the neuromuscular junction. Curr Opin Neurol 25(5):523–529

    Article  CAS  Google Scholar 

  2. Matthews I, Chen S, Hewer R, McGrath V, Furmaniak J, Rees SB (2004) Muscle-specific receptor tyrosine kinase autoantibodies–a new immunoprecipitation assay. Clin Chim Acta 348(1–2):95–99

    Article  CAS  Google Scholar 

  3. Zisimopoulou P, Evangelakou P, Tzartos J et al (2014) A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis. J Autoimmun 52:139–145

    Article  CAS  Google Scholar 

  4. Querol L, Illa I (2013) Myasthenia gravis and the neuromuscular junction. Curr Opin Neurol 26(5):459–465

    Article  Google Scholar 

  5. Andersen JB, Engeland A, Owe JF, Gilhus NE (2010) Myasthenia gravis requiring pyridostigmine treatment in a national population cohort. Eur J Neurol 17(12):1445–1450

    Article  CAS  Google Scholar 

  6. Carr AS, Cardwell CR, McCarron PO, McConville J (2010) A systematic review of population based epidemiological studies in myasthenia gravis. BMC Neurol 10:46

    Article  Google Scholar 

  7. Heldal AT, Owe JF, Gilhus NE, Romi F (2009) Seropositive myasthenia gravis: a nationwide epidemiologic study. Neurology 73(2):150–151

    Article  Google Scholar 

  8. Pakzad Z, Aziz T, Oger J (2011) Increasing incidence of myasthenia gravis among elderly in British Columbia, Canada. Neurology 76(17):1526–1528

    Article  Google Scholar 

  9. Casetta I, Fallica E, Govoni V, Azzini C, Tola M, Granieri E (2004) Incidence of myasthenia gravis in the province of Ferrara: a community-based study. Neuroepidemiology 23(6):281–284

    Article  CAS  Google Scholar 

  10. Matsuda M, Dohi-Iijima N, Nakamura A et al (2005) Increase in incidence of elderly-onset patients with myasthenia gravis in Nagano Prefecture, Japan. Intern Med 44(6):572–577

    Article  Google Scholar 

  11. Poulas K, Tsibri E, Kokla A et al (2001) Epidemiology of seropositive myasthenia gravis in Greece. J Neurol Neurosurg Psychiatry 71(3):352–356

    Article  CAS  Google Scholar 

  12. Somnier FE (2005) Increasing incidence of late-onset anti-AChR antibody-seropositive myasthenia gravis. Neurology 65(6):928–930

    Article  CAS  Google Scholar 

  13. Aarli JA (2008) Myasthenia gravis in the elderly: is it different. Ann N Y Acad Sci 1132:238–243

    Article  Google Scholar 

  14. Evoli A, Batocchi AP, Minisci C, Di SC, Tonali P (2000) Clinical characteristics and prognosis of myasthenia gravis in older people. J Am Geriatr Soc 48(11):1442–1448

    Article  CAS  Google Scholar 

  15. Sanders DB, Wolfe GI, Benatar M et al (2016) International consensus guidance for management of myasthenia gravis: executive summary. Neurology 87(4):419–425

    Article  Google Scholar 

  16. Fan L, Ma S, Yang Y, Yan Z, Li J, Li Z (2019) Clinical differences of early and late-onset myasthenia gravis in 985 patients. Neurol Res 41(1):45–51

    Article  Google Scholar 

  17. Slesak G, Melms A, Gerneth F, Sommer N, Weissert R, Dichgans J (1998) Late-onset myasthenia gravis. Follow-up of 113 patients diagnosed after age 60. Ann N Y Acad Sci 841:777–80

    Article  CAS  Google Scholar 

  18. Murai H, Yamashita N, Watanabe M et al (2011) Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey. J Neurol Sci 305(1–2):97–102

    Article  Google Scholar 

  19. Alkhawajah NM, Oger J (2013) Late-onset myasthenia gravis: a review when incidence in older adults keeps increasing. Muscle Nerve 48(5):705–710

    Article  Google Scholar 

  20. Donaldson DH, Ansher M, Horan S, Rutherford RB, Ringel SP (1990) The relationship of age to outcome in myasthenia gravis. Neurology 40(5):786–790

    Article  CAS  Google Scholar 

  21. Sakai W, Matsui N, Ishida M et al (2016) Late-onset myasthenia gravis is predisposed to become generalized in the elderly. eNeurologicalSci 2:17–20

    Article  Google Scholar 

  22. Evoli A, Batocchi AP, Palmisani MT, Lo MM, Tonali P (1992) Long-term results of corticosteroid therapy in patients with myasthenia gravis. Eur Neurol 32(1):37–43

    Article  CAS  Google Scholar 

  23. Evoli A, Batocchi AP, Tonali P (1996) A practical guide to the recognition and management of myasthenia gravis. Drugs 52(5):662–670

    Article  CAS  Google Scholar 

  24. Matell G (1987) Immunosuppressive drugs: azathioprine in the treatment of myasthenia gravis. Ann N Y Acad Sci 505:589–594

    Article  CAS  Google Scholar 

  25. Wang L, Zhang S, Xi J et al (2017) Efficacy and safety of tacrolimus for myasthenia gravis: a systematic review and meta-analysis. J Neurol 264(11):2191–2200

    Article  CAS  Google Scholar 

  26. Palace J, Newsom-Davis J, Lecky B (1998) A randomized double-blind trial of prednisolone alone or with azathioprine in myasthenia gravis. Myasthenia Gravis Study Group. Neurology 50(6):1778–1783

    Article  CAS  Google Scholar 

  27. Kapinas K, Kimiskidis VK, Kazis AD, Kokkas B, Tsolaki M, Georgiadis G (1999) Myasthenia gravis: correlation of age with clinical course and anti-AChr antibody levels. Int J Immunopathol Pharmacol 12(3):127–131

    Article  CAS  Google Scholar 

  28. Tsuchida M, Yamato Y, Souma T et al (1999) Efficacy and safety of extended thymectomy for elderly patients with myasthenia gravis. Ann Thorac Surg 67(6):1563–1567

    Article  CAS  Google Scholar 

  29. Chan KH, Cheung RT, Mak W, Ho SL (2007) Nonthymoma early-onset- and late-onset-generalized myasthenia gravis–a retrospective hospital-based study. Clin Neurol Neurosurg 109(8):686–691

    Article  CAS  Google Scholar 

Download references

Funding

This research is supported by the National Nature Science Foundation of China (grant number: 81771364).

Author information

Authors and Affiliations

  1. Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People’s Republic of China

    Yi Li, Xiaohua Dong, Zhibin Li, Yuyao Peng, Wanlin Jin, Ran Zhou, Fei Jiang, Liqun Xu, Zhaohui Luo & Huan Yang

Authors
  1. Yi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaohua Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhibin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuyao Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wanlin Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ran Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fei Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liqun Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhaohui Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Huan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Huan Yang: Conception, study design, and interpretation of the results. Yi Li: Manuscript writing and interpretation of the results. Xiaohua Dong, Zhibing Li, Yuyao Peng, Wanlin Jin, Ran Zhou, and Fei Jiang participated in the collection of data. Liqun Xu and Zhaohui Luo: Revision of the manuscript.

Corresponding author

Correspondence to Huan Yang.

Ethics declarations

Ethical approval

The study was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University. All participants were informed and signed the consent form for the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (SAV 24 KB)

Supplementary file2 (SAV 9 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Y., Dong, X., Li, Z. et al. Characteristics of myasthenia gravis in elderly patients: a retrospective study. Neurol Sci 43, 2775–2783 (2022). https://doi.org/10.1007/s10072-021-05599-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-021-05599-z

Keywords

Search

Navigation