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Fast Facts: Recognizing Refractory Myasthenia Gravis

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Fast Facts: Recognizing Refractory Myasthenia Gravis

By Nicholas J Silvestri and
Jacqueline A Palace

Published 2018

48 pages, 9 illustrations

ISBN 9781910797532



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The electronic edition has been made freely available to download until 1 March 2019, courtesy of Alexion®.
Alexion®, and many other stakeholders, received the opportunity to review the manuscript prior to publication. Full editorial control was retained by the authors and Health Press Limited. Further review comments are invited below for the authors’ consideration.


An in-depth look at a rare disease

Myasthenia gravis (MG) is a rare autoimmune disorder of the neuromuscular junction, characterized by muscle fatigability. Patients often initially present with ocular symptoms, but in most cases the disease spreads beyond the eye muscles to more generalized involvement of bulbar, facial, neck, proximal limb and respiratory muscles. With adequate treatment, most patients with MG are able to live productive lives with few or no symptoms, but a distinct subset of patients do not respond to conventional treatment. With new treatment options on the horizon, it is important that these patients are identified. 

Fast Facts: Recognizing Refractory Myasthenia Gravis takes an in-depth look at:

  • the immune-mediated nature of MG
  • classification of MG by disease type and severity, and antibody status
  • clinical presentation and diagnostic work-up
  • conventional management options
  • how patients with treatment-refractory MG present
  • the assessment tools that can be used to identify non-responders.

This informative resource will be of value to neurologists, neurology trainees and ophthalmologists caring for patients with this rare disease, as well as patients with MG who wish to have a deeper dialog with their doctor or patient group.


  • Definition and epidemiology
  • Pathophysiology and classification
  • Diagnosis and management: an overview
  • Assessment of disease severity and treatment response


“ ... clearly written and full of useful information about this much misunderstood condition.”

Ruth Ingledew, Chief Executive Officer, myaware

“A good concise summary of refractory generalized myasthenia gravis, from two neurologists with high expertise in this field.”

Professor Rudolf Janzen, German Myasthenia Gravis Association



The authors

Nicholas J Silvestri


Clinical Associate Professor of Neurology, Jacobs School of Medicine and Biomedical Sciences; Department of Neurology, Buffalo General Hospital

Jacqueline A Palace


Consultant Neurologist, Nuffield Department of Clinical Neurosciences, Oxford


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Comments for the authors

Janzen R.W.C., Germany 04 Apr 2018

concerning Fig.4.1 is a good platform für the early phase. The problem is the optimal individual step for "escalation" of aggressive treatment. My opinion would be: after adequate azathioprine change to mycophenolate mofetil, my be ciclosporine, there after think for rituximab. May be there should be a Fig. 4.2 ?


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