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Myasthenia Gravis

ACR Antibody levels

09/30/2009

Question:

When diagnosed with MG by a positive antibody blood test, is there a significance to the amount of antibodies found in your blood? Like the higher the levels, the worse the disease may be for that person?

Answer:

Antibodies do not correlate well with clinical severity, although I some physicians use these tests to feel more comfortable about how well the disease is being controlled. Usually the clinical exam and the history is enough (serial examinations). There have been some studies looking at the antibodies and the effect of certain treatments, like thymectomy and immunosuppression. Engel* detailed reports of decreases in antibody titers by 50% sustained for more than 12 months being associated with clinical improvement. Serial measurement of the antibodies may be useful for following the basic trend of myasthenia in severely affected patients. Personally, I have only done it once, and it was a gentleman who I had significant difficulty weaning off a ventilator despite repeated aggressive plasmapheresis when I was looking for some indicator that I was being effective in treatment.

{Citation: Engel, A & Hohlfeld, R. Acquired Autoimmune Myasthenia Gravis. Myology, 3rd edition, 2004.pg 1774) (Limburg PC et al. Anti-acetylcholine receptor antibodies in myasthenia gravis. Part 1. Relation to clinical parameters in 250 patients. J Neurol Science 58:357-370, 1983.)(Seybold ME et al. Patterns of acetylcholine receptor antibody fluctuation in myasthenia gravis. Ann NY Acad Sci 377:678-690, 1981.)}

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati