Development of Generalized Myasthenia Gravis in Patients With Ocular Myasthenia Gravis

Kupersmith et al¹ provided data suggesting that low doses of corticosteroids in patients with ocular myasthenia gravis (MG) may prevent the development of generalized MG. We looked at the MG registry kept in the Department of Neurology of the University Hospital of Patras in Greece to contribute our data to this controversial issue.

Twenty-eight patients with ocular MG (grade 1 in the scale developed by Osserman and Genkins²) (mean ± SD age at diagnosis, 48.6 ± 21.5 years; range, 15-80 years; 17 [61%] men) have received follow-up for at least 8 years. Of those, 9 (32%) developed generalized MG within 2 years and 11 (39%) within 8 years of the initial diagnosis. Twenty-one patients who responded well to pyridostigmine bromide had no steroid treatment; 7 patients unresponsive to pyridostigmine were treated with prednisone. The prednisone dosage was gradually increased to 60 mg on alternate days and then gradually reduced to the smallest dosage that controlled the symptoms (5-10 mg on alternate days).