Clinical Manifestations of Acetylcholine Receptor Antibody Positive and Negative Myasthenia Gravis
Nath Pasutharnchat MD*, Supaporn Wacharapluesadee PhD**, Thiravat Hemachudha MD*,**
Affiliation : * Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ** Neuroscience Center for Research and Development & WHO Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Background : Acquired myasthenia gravis (MG) is the most common neuromuscular junction disorder. Acetylcholine
receptor (AChR) antibody is found in the majority of MG.
Objective : Describe and compare the clinical manifestations of MG patients with and without the presence of serum AChR
antibody.
Material and Method: Between 2009 and 2010, 90 cases with MG, treated at the adult neurology service of King Chulalongkorn
Memorial Hospital were consecutively recruited. Serum AChR antibody was measured by enzyme linked immunosorbent
assay. Result of 0.45 nmole per liter or over is considered positive. Patients were divided into two groups based on serological
status. Demographic data and clinical parameters were recorded and compared.
Results : Mean age was 47.5 + 15.6 years. Sixty-eight (75.5%) were female. Twenty-two (24.4%) had ocular MG and sixty-
eight (75.6%) had generalized MG. Mean age of onset was 40.9 + 15.2 years. Sixty-seven (74.4%) were AChR antibody
positive and twenty-three (25.6%) were AChR antibody negative. Limb/ocular-limb weakness was more commonly found
in AChR antibody positive (p = 0.12) while pure ocular weakness was significantly found in AChR antibody negative
(p = 0.006*). Myasthenic crisis (MC) tended to develop in AChR antibody positive (p = 0.06). Numbers of patients with
moderate to severe weakness were significantly higher in AChR antibody positive (p = 0.04*). Thymic pathology was found
in 72.3% of thymectomized AChR antibody positive patients. None of thymectomized seronegative patients had abnormal
thymus. Good response to acetylcholine esterase inhibitors was more frequent in AChR antibody positive patients
(p = 0.009*). Immunotherapy and thymectomy (p = 0.001*) were more frequently provided in AChR antibody positive
patients.
Conclusion : AChR antibody positive MG manifested more severe, generalized weakness with frequent MC. Abnormal
thymic histopathology was more frequently found in AChR antibody positive MG. Response to ACEI was better in AChR
antibody positive group. However, overall outcomes of both groups were favorable without any difference.
Keywords : Myasthenia gravis, Acetylcholine receptor antibody, Clinical manifestation
