Myasthenia Gravis Clinic

Myasthenia Gravis Patient Care:

We provide comprehensive care of patients with myasthenia gravis.  Myasthenia Gravis is an autoimmune disease where patients develop antibodies against the neuromuscular junction.  This interferes with the communication between nerves and muscles and produces fatiguing weakness.  Ocular symptoms are usually the first symptoms to develop.  Patients develop dropping of the eyes (ptosis) and double vision (diplopia).  Usually the symptoms are worse with activity or later in the day.  As the disease progresses patient might develop swallowing and speech difficulties.  Patient can develop generalized weakness and in severe cases respiratory difficulties.  These symptoms also are worse with activity and later in the day.

Eighty percent of patients have antibodies to the acetylcholine receptors that are found in the neuromuscular junction of muscle..  Half of the remainiing patients have antibodies against MuSK that regulate  the development of the neuromuscular junstion.  A smaller percentage have antibodies against LRP4 and Agrin  and in the remainder we are unable to detect antibodies.  We call those patients Quad negative MG patients. 

In addition to a comprehensive examination and antibody testing electrophysiological testing is important in the daignosis of Myasthenia Gravis.  We offer electrophysiological testing including repetitive nerve stimulation and single fiber EMG testing.

Myasthenia Gravis is treatable with pryridostigmine, prednisone and other immunosuppresant medications.  Often with these treatments patients will acheive clinical remission.  Thymectomy will help many patients with Mysthenia Gravis.  For patients who do not respond to the above therapies we offer therapy with IVIG, Plasma Exchange, complement inhibitors such as Soliris or FCRN blockers such as Vyvgart.   Drs Rivner and Barnes have years of experience in treating Myasthenia Gravis and most patients with these modalities are sucessfully treated.

Myasthenia Gravis Research

AU Health is involved  many clinical trials in Myasthenia Gravis.  LRP4 the Agrin receptor that activates MuSK was discovered by AU Researchers.  The pioneering studies on LRP4 and Agrin MG were done at AU.  We had been involved in many of the major clinical studies for MG including studies on eculizumab, ravulizumab, thymectomy and IVIG.  Currently we are working on many clinical trials in MG.

• Raise Study--monoclonal antibody against C5 (Zilucoplan) given subcutaneously
• Efgartigimod (Vyvgart) in Myasthenia Gravis--looking at different dosage schedules and routes of administration
• Car-T study--T cells expressing Chimeric antigen receptor directed against B Cell maturation antigen
• Nipocalimab--Monoclonal antibody that binds and blocks FCRN receptors in MG
• Rozanolixizumab--Monoclonal antibody that blocks FCRN receptors (Completed)
• Inebilizumab--Monoclonal antibody against CD-19--B Cell specific surface antigen in MG
• Alexion Registry Study--Observational Study for patients getting eculizumab and ravulizumab