86 - Myasthenia gravis in children

Abstract

Myasthenia gravis (MG) in children shares a similar pathophysiology with adults, however, there are important differences in epidemiology, clinical manifestation, and treatment. Gender and seropositivity ratios differ based on puberty. Seropositivity to acetylcholine receptor antibodies is less frequent among juvenile MG, especially with early onset, limiting its value in the diagnosis of juvenile MG. Generalized MG patients tend to show subtle female predominance, older age of onset, and predominantly European descent. Ocular MG patients had a more pronounced female predominance, younger age of onset, and predominantly Asian ethnicity. There was a tendency that younger children developed ocular MG, and older children, generalized MG. Progression of ocular MG to generalized MG increase with age, showing the highest incidence with post-pubertal onset. Children with post-pubertal onset showed more severe MG. Ptosis and strabismus in children with MG can cause amblyopia. Steroids should be used with caution in children. Steroid-sparing agents such as azathioprine are mostly helpful in adults with MG, which could be hardly effective in juvenile MG, and may result in secondary malignancies. Thymoma is rare in children, but could be malignant.