Abstract
Autoimmune myasthenia gravis (MG) is the prototypic, antibody-mediated neuromuscular disease and is characterized by a decrease in the number of functional acetylcholine receptors (AChR) within the muscle end plate zone of the neuromuscular junction (NMJ). Although the pathophysiology of AChR-mediated myasthenia gravis has been extensively studied over the last 40 years since its original description by Patrick and Lindstrom (Science 180:871–872, 1973), less is known about the much more recently described muscle-specific kinase (MuSK) antibody-mediated MG. MuSK-MG has features clinically distinct from Ach-R MG, as well as a different pattern of response to treatment and a unique immunopathogenesis.
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Marstellar HB. The first American case of myasthenia gravis. Arch Neurol. 1988;45:185–7.
Pascuzzi RM. The history of myasthenia gravis. Neurol Clin. 1994;12:231–42.
Patrick J, Lindstrom J. Autoimmune response to acetylcholine receptor. Science. 1973;180:871–2.
Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol. 2009;8:475–90.
Sanders DB, El-Salem K, Massey JM, et al. Clinical aspects of MuSK antibody positive seronegative MG. Neurology. 2003;60:1978–80.
Hoch W, McConville J, Sigrun H, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patient with myasthenia gravis without acetylcholine receptor antibodies. Nat Med. 2001;7(3):365–8.
Guptill J et al. Characterization of B cells in muscle-specific kinase antibody myasthenia gravis. Neurology: Neuroimmunol Neuroinflamm. 2015;2(2):e77. This paper explores and suggests a more definitive pathophysiology and immune mechanism for MuSK MG which may have an impact on future management.
Koneczny I, Cossins J, Vincent A. The role of muscle-specific tyrosine kinase (MuSK) and mystery of MuSK myasthenia gravis. J Anat. 2014;224:29–35.
Tsonis AI, Zisimopoulou P, Lazaridis K, et al. MuSK autoantibodies in myasthenia gravis detected by cell based assay—a multinational study. J Neuroimm. 2015;284:10–7.
Yi JS et al. Characterization of CD4 and CD8 T cell response in MuSK myasthenia gravis. J Autoimmun. 2014;52:130–8. This papers explores and suggests a more definitive pathophysiology and immune mechanism for MuSK MG which may have an impact on future management.
Evoli A, Tonali PA, Padua L, et al. Clinical correlates with anti-MuSK antibodies in generalized seronegative myasthenia gravis. Brain. 2003;126:2304–11.
Deymeer F, Gungor-Tuncer O, Yilmaz V, et al. Clinical Comparison of anti-MuSK vs. anti-AChR-positive and seronegative myasthenia gravis. Neurology. 2007;68:609–11.
Evoli A, Padua L. Diagnosis and therapy of myasthenia gravis with antibodies to muscle-specific kinase. Autoimmun Rev. 2013;12:931–5. This paper reviews clinical, diagnostic and management of MuSK MG based on current evidence.
Benveniste O et al. MuSk antibody positive myasthenia gravis plasma modifies MURF-1 expression in C2C12 cultures and mouse muscle in vivo. J Neuroimmunol. 2005;170(1-2):41–8.
Sanders DB, Guptill J. Myasthenia gravis and Lambert-Eaton myasthenic syndrome. Continuum. 2014;20(5):1413–25.
Stickler DE, Massey JM, Sanders DB. MuSK-antibody positive myasthenia gravis: clinical and electrodiagnosic patterns. Clin Neurophysiol. 2005;116:2065–8.
Vincent A et al. Seronegative generalized myasthenia gravis: clinical features, antibodies and their targets. Lancet. 2003;2:99–106.
Hatanaka Y, Hemmi S, Morgan MB, et al. Nonresponsiveness to anticholinesterase agents in patients with MuSK-antibody-positive MG. Neurology. 2005;65(9):1508–9.
Hain B, Jordan K, Deschauer M, Zierz S. Successful treatment of MuSK antibody-positive myasthenia gravis with rituximab. Muscle Nerve. 2006;33:575–80.
Evoli A, Alboini PE, Damato V, Iorio R. 3,4-Diaminopyridine may improve myasthenia gravis with MuSK antibodies. Neurology. 2016;86(11):1070–1.
Hobson-Webb L. Comment: is 3,4-diaminopyridine a new option in treating MuSK MG? Neurology. 2016;86(11):1071.
Lauriola L, Ranelletti F, Maggiano N, et al. Thymus changes in anti-MuSK-positive and negative myasthenia gravis. Neurology. 2005;64:536–8.
Guptill J, Sanders DB, Evoli A. Anti-MuSk antibody myasthenia gravis: clinical findings and response to treatment in two large cohorts. Musc and Nerv. 2011;44:36–40.
Juel V, Massey J. Myasthenia gravis. Orphanet J Rare Disease. 2007;2:44.
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Hurst, R.L., Gooch, C.L. Muscle-Specific Receptor Tyrosine Kinase (MuSK) Myasthenia Gravis. Curr Neurol Neurosci Rep 16, 61 (2016). https://doi.org/10.1007/s11910-016-0668-z
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DOI: https://doi.org/10.1007/s11910-016-0668-z