Myasthenia gravis in Jamaica: clinical, immunological and genetic studies

ABSTRACT

Clinical, immunological and genetic parameters were studied in 73 Jamaican patients with myasthenia gravis (Mg). The reported biomodal clinical distribution of females with early onset of disease and males with late onset was not observed. The female to male ratio was 21. The most frequent manifestations of disease were ptosis (84.9 percent), general muscle weakness (68.5 percent), bulbar symptoms (41.1 percent) and diplopia (32.9 percent). Unusual presenting features such as unilateral ptosis, recurrent chest infection and stumbling while walking resulted in diagnosis being missed in 5.8 percent of cases. The sensitivity of radiommunoassay in detecting acetylcholine receptor antibody (AchR-Ab) in sera from a subgroup of 35 MG patients was 71.4 percent whilst that of the ELISA was only 14.2 percent. There was no correlation between HLA-type, thymic pathology and course of disease. HTLV-I could not be implicated in the pathogenesis of this disease. There was a paucity of other associated autoimmune conditions among MG patients. Thymectomy was an important therapeutic modality in that improvement was observered in 22 cases and remission in 11. (AU)