Myasthenia gravis with hypergammaglobulinaemia and antibodies

Abstract

Myasthenia gravis is a disease characterized by fluctuating paresis of skeletal muscle, and often con- tinuing weakness is present. The pathophysiology responsible for the fluctuating weakness is localized in the neuromuscular junction: most probably the basic disturbance is a defect in the (re) synthesis of acetylcholine The permanent residual weakness may be due to a change in the receptor membrane of the muscle. Zacks, Bauer, and Blumberg (1962), using the electron microscope, reported some changes in the clefts of the second order. Certain electromyographic findings also point to a change in the functioning of the muscle itself. In addition to these local abnormalities, which eluci- date the clinical findings, there is increasing evidence that in myasthenia gravis the immunological defence mechanism is functioning in an abnormal way. Nastuk, Plescia, and Osserman (1960) were the first to describe abnormal fluctuations in the serum com- plement level in myasthenic patients, and Strauss, Seegal, Hsu, Burkholder, Nastuk, and Osserman (1960), using the immunofluorescent technique with skeletal muscle, demonstrated that gamma globulin from sera of 13 of 30 patients with myasthenia was fixed to skeletal muscle.