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Thymus and Myasthenia Gravis. Pathophysiological and Clinical Features

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Thymus Gland Pathology

Abstract

In 1672 Thomas Willis published a book, “De anima brutorum” in which he wrote about “a woman who temporarily lost her power of speech and became mute as a fish” [1]. This has been interpreted as being the first written description of myasthenia gravis (MG). Others give credit to Wilks for the first report of disease in 1877, characterized as a bulbar palsy without anatomic lesion [2]. The first reasonably complete accounts were those of Erb in 1878 and Goldflam in 1893 [3, 4] and for many years thereafter, the disorder was referred to as the Erb- Goldflam syndrome. Jolly was the first to use the name myasthenia gravis in 1895 and to demonstrate the “myasthenic reaction” of muscle repeatedly stimulated by Faradism [5], introducing the basic criteria of instrumental techniques of MG diagnosis, the repetitive nerve stimulation, elaborated later by Desmedt [6].

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References

  1. Willis T (1672) De anima brutorum quae hominis vitalis ac sensitiva est (exercitationes duae). Ric Davis, Oxford

    Google Scholar 

  2. Wilks S (1877) On cerebritis, hysteria and bulbar paralysis, as illustrative of arrest of function of the cerebrospinal centres. Guys Hosp Rep 22:7–55

    Google Scholar 

  3. Erb W (1879) Zur Casuistik der bulbaren Lähmungen. über einen neuen, wahrscheinlich bulbaren Symptomencomplex. Arch Psychiatr Nervenkr 9:336–350

    Google Scholar 

  4. Goldflam S (1893) Über einen scheinbar heilbaren bulbärparalytischen symptomenkomplex mit beteiligung der extremitäten. Dtsch Z Nervenheilk 4:312–352

    Article  Google Scholar 

  5. Jolly F (1895) Über Myastenia gravis pseudoparalytica. Berl Klin Wochenschr 32:1–7

    Google Scholar 

  6. Desmedt JE (1973) The neuromuscular disorder in myasthenia gravis. In: Desmedt JC (ed) New developments in electromyography and clinical neurophysiology. Karger, Basel, pp 241–304

    Google Scholar 

  7. Walker MB (1934) Treatment of myasthenia gravis with physostigmine. Lancet 1:1200–1201

    Article  Google Scholar 

  8. Dale HH, Feldberg W, Vogt M (1936) Release of acetylcholine at voluntary motor nerve endings. J Physiol 86:353–380

    PubMed  CAS  Google Scholar 

  9. Weigert C (1901) Pathologisch-anatomischer beitrag zur erb’schen krankheit (Myasthenia gravis). Neurol Centr Bl 20:597–601

    Google Scholar 

  10. Sauerbruch F, Schumacher ED (1911) Technik der Thoraxchirurgie. Julius Springer, Berlin

    Google Scholar 

  11. Castleman B, Norris EH (1949) The pathology of the thymus in myasthenia gravis. A study of 35 cases. Medicine 28:27–58

    PubMed  CAS  Google Scholar 

  12. Patrick S, Lindstrom J (1973) Autoimmune response to acetylcholine receptor. Science 180:871–872

    Article  PubMed  CAS  Google Scholar 

  13. Fambrough DM, Drachman DB, Santyamurti S (1973) Neuromuscular junction in myasthenia gravis: Decreased acetylcholine receptors. Science 182:293–295

    Article  PubMed  CAS  Google Scholar 

  14. Lennon VA, Lindstrom JM, Seybold ME (1976) Experimental autoimmune myasthenia gravis: Cellular and humoral immune responses. Ann N Y Acad Sci 274:283–299

    Article  PubMed  CAS  Google Scholar 

  15. Buckley C, Douek D, Newsom-Davis J (2001) Immature long lived CD4+ and CD8+ cells are generated by the Thymoma in myasthenia gravis. Ann Neurol 50:64–72

    Article  PubMed  CAS  Google Scholar 

  16. Vincent A, Palace J, Hilton-Jones D (2001) Myasthenia gravis. Lancet 357(9274):2122–2128

    Article  PubMed  CAS  Google Scholar 

  17. Papazian O (1992) Transient neonatal myasthenia gravis. J Child Neurol 7:135–141

    Article  PubMed  CAS  Google Scholar 

  18. Drachman DB (1994) Myasthenia gravis. N Engl J Med 330:1797–1810

    Article  PubMed  CAS  Google Scholar 

  19. Engel AG, Arahata K (1987) The membrane attack complex of complement at the endplate in myasthenia gravis. Ann N Y Acad Sci 05:326–332

    Article  Google Scholar 

  20. Hoch W, McConville J, Helms S et al (2001) Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med 7:365–368

    Article  PubMed  CAS  Google Scholar 

  21. Hanisch F, Eger K, Zierz S (2006) MuSK-antibody positive pure ocular myasthenia gravis. J Neurol 253:659–660

    Article  PubMed  Google Scholar 

  22. Sanders DB, El-Salem K, Massey JM et al (2003) Clinical aspects of MuSK antibody positive seronegative MG. Neurology 60:1978–1980

    PubMed  CAS  Google Scholar 

  23. Romi F, Aarli JA, Gilhus NE (2005) Seronegative myasthenia gravis: Disease severity and prognosis. Eur J Neurol 12:413–418

    Article  PubMed  CAS  Google Scholar 

  24. Verma PK, Oger JJ (1992) Seronegative generalized myasthenia gravis: Low frequency of thymic pathology. Neurology 42:586–589

    PubMed  CAS  Google Scholar 

  25. Zhou L, McConville J, Chaudhry V et al (2004) Clinical comparison of muscle-specific tyrosine kinase (MuSK) antibody-positive and-negative myasthenic patients. Muscle Nerve 30:55–60

    Article  PubMed  CAS  Google Scholar 

  26. Meriggioli MN, Sanders DB (2004) Myasthenia gravis: Diagnosis. Semin Neurol 24:31–39

    Article  PubMed  Google Scholar 

  27. Sanders DB, Massey JM (2002) The diagnostic utility of anti-striational antibodies in myasthenia gravis. Neurology 58:A229

    Google Scholar 

  28. Voltz RD, Albrich WC, Nagele A et al (1997) Paraneoplastic myasthenia gravis: Detection of anti-MGT30 (titin) antibodies predicts thymic epithelial tumor. Neurology 49:1454–1457

    PubMed  CAS  Google Scholar 

  29. Chen XJ, Qiao J, Xiao BG, Lu CZ (2004) The significance of titin antibodies in myasthenia gravis-correlation with thymoma and severity of myasthenia gravis. J Neurol 251:1006–1011

    Article  PubMed  Google Scholar 

  30. Romi F, Skeie GO, Gilhus NE, Aarli JA (2005) Striational antibodies in myasthenia gravis: Reactivity and possible clinical significance. Arch Neurol 62:442–446

    Article  PubMed  Google Scholar 

  31. Wekerle H, Ketelsen UP (1977) Intrathymic pathogenesis and dual genetic control of myasthenia gravis. Lancet 1(8013):678–680

    Article  PubMed  CAS  Google Scholar 

  32. Kirchner T, Hoppe F, Schalke B, Müller-Hermelink HK (1988) Microenvironment of thymic myoid cells in myasthenia gravis. Virchows Arch B54:295–302

    Google Scholar 

  33. Marx A, Wilisch A, Schultz A et al (1997) Pathogenesis of myasthenia gravis. Virchows Arch 430:355–364

    Article  PubMed  CAS  Google Scholar 

  34. Utsugisawa K, Nagane Y, Tohgi H (2000) Marked increase in CD44-highly positive cells in hyperplastic thymuses from patients with myasthenia gravis. Muscle Nerve 23:507–513

    Article  PubMed  CAS  Google Scholar 

  35. Roxanis I, Micklem K, Willcox N (2001) True epithelial hyperplasia in the thymus of early-onset myasthenia gravis patients: Implications for immunopathogenesis. J Neuroimmunol 112:163–173

    Article  PubMed  CAS  Google Scholar 

  36. Sommer N, Willcox N, Harcourt GC, Newsom-Davis J (1990) Myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor reactive T cells. Ann Neurol 28:312–319

    Article  PubMed  CAS  Google Scholar 

  37. Tolosa E, Li W, Yasuda Y et al (2003) Cathepsin V is involved in the degradation of invariant chain in human thymus and is overexpressed in myasthenia gravis. J Clin Invest 112:517–526

    PubMed  CAS  Google Scholar 

  38. Schwimmbeck PL, Dyrberg T, Drachman DB, Oldstone MB (1989) Molecular mimicry and myasthenia gravis. An autoantigenic site of the acetylcholine receptor alpha-subunit that has biologic activity and reacts immunochemically with herpes simplex virus. J Clin Invest 84:1174–1180

    Article  PubMed  CAS  Google Scholar 

  39. Carlsson B, Wallin J, Pirskanen R et al (1990) Different HLA DR-DQ associations in subgroups of idiopathic myasthenia gravis. Immunogenetics 1:285–290

    Article  Google Scholar 

  40. Niks EH, Kuks JB, Roep BO et al (2006) Strong association of MuSK antibody-positive myasthenia gravis and HLA-DR14-DQ5. Neurology 66:1772–1774

    Article  PubMed  CAS  Google Scholar 

  41. Wilisch A, Gutsche S, Hoffacker V et al (1999) Association of acetylcholine receptor alpha-subunit gene expression in mixed thymoma with myasthenia gravis. Neurology 52:1460–1466

    PubMed  CAS  Google Scholar 

  42. Grob D, Arsura EL, Brunner NG, Namba T (1987) The course of myasthenia gravis and therapies affecting outcome. Ann N Y Acad Sci 505:472–499

    Article  PubMed  CAS  Google Scholar 

  43. Oosterhuis HJ (1989) The natural course of myasthenia gravis: A long term follow up study. J Neurol Neurosurg Psychiatry 52:1121–1127

    Article  PubMed  CAS  Google Scholar 

  44. Weinberg DH, Rizzo JF 3rd, Hayes MT et al (1999) Ocular myasthenia gravis: Predictive value of single-fiber electromyography. Muscle Nerve 22:1222–1227

    Article  PubMed  CAS  Google Scholar 

  45. Sethi K, Rivner MH, Swift TR (1987) The ice pack test for myasthenia gravis. Neurology 37:1383–1385

    PubMed  CAS  Google Scholar 

  46. Golnik KC, Pena R, Lee AG, Eggenberger ER (1999) An ice test for the diagnosis of myasthenia gravis. Ophthalmology 106:1282–1286

    Article  PubMed  CAS  Google Scholar 

  47. Gorelick PB, Rosenberg M, Pagano RJ (1981) Enhanced ptosis in myasthenia gravis. Arch Neurol 31:531

    Google Scholar 

  48. Cogan D (1965) Myasthenia gravis: A review of the disease and a description of lid twitch as a characteristic sign. Arch Ophthalmol 74:217–221

    PubMed  CAS  Google Scholar 

  49. Oh SJ, Kim DE, Kuruoglu R et al (1992) Diagnostic sensitivity of the laboratory tests in myasthenia gravis. Muscle Nerve 15:720–724

    Article  PubMed  CAS  Google Scholar 

  50. Castleman B (1966) The pathology of the thymus gland in myasthenia gravis. Ann N Y Acad Sci 135:496–505

    Article  PubMed  CAS  Google Scholar 

  51. Fujita J, Yamadori I, Yamaji Y et al (1994) Myasthenia gravis associated with small-cell carcinoma of the lung. Chest 105:624–625

    Article  PubMed  CAS  Google Scholar 

  52. Langmann A, Lindner S, Koch M, Diez J (2004) Okuläre myasthenie: Eine diagnostische und therapeutische Herausforderung-eine Übersicht. Klin Monatsbl Augenheilkd 221:77–86

    Article  PubMed  Google Scholar 

  53. Barohn RJ (2003) Standards of measurements in myasthenia gravis. Ann N YAcad Sci 998:432–439

    Article  Google Scholar 

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Capone, L., Gentile, R., Schoenhuber, R. (2008). Thymus and Myasthenia Gravis. Pathophysiological and Clinical Features. In: Lavini, C., Moran, C.A., Morandi, U., Schoenhuber, R. (eds) Thymus Gland Pathology. Springer, Milano. https://doi.org/10.1007/978-88-470-0828-1_8

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  • DOI: https://doi.org/10.1007/978-88-470-0828-1_8

  • Publisher Name: Springer, Milano

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  • Online ISBN: 978-88-470-0828-1

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