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Editorial |

Seronegative Myasthenia Gravis—A Vanishing Disorder?

Henry J. Kaminski, MD1,2
[+] Author Affiliations
1Department of Neurology, George Washington University, Washington, DC
2Department of Pharmacology and Physiology, George Washington University, Washington, DC
JAMA Neurol. 2016;73(9):1055-1056. doi:10.1001/jamaneurol.2016.2277.
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With the initial identification in 1976 of antibodies directed toward the acetylcholine receptor (AChR) in the serum of patients with myasthenia gravis (MG),1 it became clear that upwards of 20% of patients with clinical and electrophysiological evidence of a neuromuscular disorder lacked such antibodies. Was this because of the presence of low-affinity antibodies that were capable of disease induction but not detectable by the standard radioimmunoassay? This answer appears to be partially the case. Using cell-based assays that present the complex pentameric, membrane-bound AChR in a much more native state, AChR antibodies can be found among seronegative patients.2 However, Lindstrom et al1 suggested another possibility that antibodies may be directed toward other target antigens and produce a similar clinical and electrophysiological disorder.

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