Pediatric ocular myasthenia gravis: Case report and literature review

Solano, Adriana; Jimeno, Verónica; Montoya, Luisa; Espinosa, Natalia

doi:10.4103/pajo.pajo_11_19

Cited by 4 publications

(14 citation statements)

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“…The most commonly affected muscle is the extraocular muscle, as it has a less number of ACH receptors. 1 There are three types of MG in children:…”

Section: Discussionmentioning

confidence: 99%

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An Ocular Myasthenia Gravis: A Case Report

Ajlan¹,

Al-Ghatam²

2023

JBMS

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Myasthenia gravis (MG) is an autoimmune disease involving the postsynaptic receptors in the neuromuscular junction, characterized by weakness of the muscles. Ocular myasthenia gravis is a subtype of disease where weakness of oculomotor muscles usually occurs with the presence of ptosis. MG is considered a rare disease in pediatric age groups. Acetylcholinesterase inhibitors and immune-modifying medications are usually the mainstays of medication. We report here, a case of a 2-year-old that presented with ptosis and was diagnosed as ocular myasthenia gravis. Our case report describes the clinical presentation, diagnostic tests, and treatments followed.

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“…The most commonly affected muscle is the extraocular muscle, as it has a less number of ACH receptors. 1 There are three types of MG in children:…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ocular myasthenia gravis usually suffer from weakness in the eyelid elevator muscle, extraocular muscle, or orbicular muscle. 1 In the pediatric age group though rare, there are three different types of myasthenia gravis: congenital, transient neonatal and juvenile myasthenia gravis, which is the most common type.…”

Section: Introductionmentioning

confidence: 99%

An Ocular Myasthenia Gravis: A Case Report

Ajlan¹,

Al-Ghatam²

2023

JBMS

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“…Neostigmine test has been used and found to be reliable for diagnosis of MG in places where Tensilon is not easily available. 15,18 In an Indian study, the positivity rate of Neostigmine test was 93.4% for ocular MG and 97.9 % for generalized MG. 18 Our case responded well with complete resolution of ptosis with Neostigmine. Neurophysiological testing requires the skills of a trained paediatric neurophysiologist and is difficult in children due to reduced cooperation with needle placement.…”

Section: Case Notementioning

confidence: 98%

“…The Ice-pack test was used and was found to be reliably positive in case reports of ocular as well as generalized MG, both in children and adults, in case reports from different part of the world. 14,15 Ice-pack test has very high sensitivity and specificity for both ocular and generalized MG. 4 Ice-pack test has sensitivities of 94% and 82% and specificities of 97% and 96% for ocular and generalized MG respectively. 16 The Tensilon test involves intravenous infusion of Tensilon, a fast-acting, short duration Cholinesterase inhibitor.…”

Section: Case Notementioning

confidence: 99%

Juvenile Generalized Myasthenia Gravis: Presented as Unilateral Blepharoptosis and Successfully Managed with Pulse Intravenous Methylprednisolone

Poudel

Anand

Ghosh

2021

Kathmandu Univ. Med. J.

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Myasthenia Gravis is a rare autoimmune disorder of childhood and this is rarer in South Asia. We present a pre-pubertal 7 year old female child of seropositive Generalized Juvenile Myasthenia Gravis. She presented with unilateral blepharoptosis and later generalized symptoms appeared. Ice-pack test, Neostigmine challenge test and acetylcholine receptor antibody test were positive. Serum muscle specific tyrosine kinase antibody test was normal. She did not have thymic abnormalities. She did not respond to high dose (26 mg/kg/day) of Pyridostigmine and oral Prednisolone (2 mg/kg/day), but was successfully treated with a combination of pulse intravenous Methylprednisolone (30 mg/kg once a month for 6 months) and daily doses of oral Prednisolone (2 mg/kg/day) along with Pyridostigmine without significant side effects. This combination can be considered a potential inexpensive treatment for Juvenile Myasthenia Gravis in a resource limited area where other immunosuppressive treatments such as intravenous immunoglobulin is expensive and unaffordable.

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“…The mortality rate without treatment is 25-31%, now reduced to 4% with current therapies [ 1 ]. In the pediatric population, the incidence of OMG is 3-9.1 cases per million, and it mostly occurs in children of Asian ethnicity [ 2 ]. Treatments include cholinesterase inhibitors, thymectomy, plasmapheresis, corticosteroids, and immunosuppressive drugs.…”

Section: Introductionmentioning

confidence: 99%

Ocular Myasthenia Gravis As Unilateral Ptosis and External Ophthalmoplegia: A Case Report

Tanveer,

Tahir,

Ahmad

et al. 2024

Cureus

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Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating weakness and fatigue in ocular, bulbar, limb, or respiratory muscles. Initially, more than half of MG patients experience isolated ocular symptoms, such as ptosis, diplopia, or muscle paresis. This case report presents a unique occurrence of MG in a four-year-old female, showcasing a two-year history of sudden onset, persistent yet fluctuating unilateral ptosis accompanied by exo-deviation and adduction deficit in the right eye. No diplopia or systemic features were observed. Positive findings in tests, including the ice pack test, Cogan twitch sign, fatiguability, and neostigmine test, indicated ocular myasthenia. Electromyography revealed a decremental response, while anti-acetylcholine antibodies showed borderline results. Computed tomography of the brain ruled out central causes, and routine laboratory testing yielded normal results. Treatment with pyridostigmine and corticosteroids led to significant improvement in symptoms. This case emphasizes the diverse presentation of MG in ophthalmology, with ocular signs serving as indicators in approximately half of the cases. Early diagnosis and prompt treatment are crucial for enhancing long-term prognosis. Emergency physicians should consider MG as a potential cause for unilateral ocular symptoms after excluding central causes. Accurate diagnosis and comprehensive management of MG are complex yet essential for ensuring optimal patient health.

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Pediatric ocular myasthenia gravis: Case report and literature review

Cited by 4 publications

References 0 publications

An Ocular Myasthenia Gravis: A Case Report

An Ocular Myasthenia Gravis: A Case Report

Juvenile Generalized Myasthenia Gravis: Presented as Unilateral Blepharoptosis and Successfully Managed with Pulse Intravenous Methylprednisolone

Ocular Myasthenia Gravis As Unilateral Ptosis and External Ophthalmoplegia: A Case Report

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