Spontaneous remission in juvenile myasthenia gravis: A cohort of 13 cases and review of the literature.

ABSTRACT

We describe the clinical course of patients with juvenile myasthenia gravis who experienced spontaneous remission and review the literature. This is a retrospective study of 13 patients with spontaneous remission from a cohort of 133 patients younger than 18-years-old. We compared several variables with potential prognostic value in patients with and without spontaneous remission. Ten percent of patients (13/133) experienced spontaneous remission. There was no difference in age at onset or sex compared to the overall JMG population. Spontaneous remission occurred in 2/40 (5.0%; 95% CI 0.6-16.9) patients in Class I (ocular); in 11/53 (20.8%; 95% CI 10.8-34.1) patients in Class II-III (mild, moderate, generalized) (p < 0.0018) and in 0/40 patients in Class IV-V (severe, needs intubation). Of the AChR antibody positive patients, 10/97 (10.3%; 95% CI 5.0-18.1) had spontaneous remission, compared with 2/29 (6.9%; 95% CI 0.9-22.8) of those without AChR antibodies (p = 0.583). Strikingly, none of the 36 patients with thyroid antibodies had spontaneous remission compared with 13/58 (22.4%) of those without thyroid antibodies (95% CI 7.3-21.8; p < 0.001). Ten percent of patients with juvenile myasthenia gravis achieved spontaneous remission, mainly in those with Class II-III disease and no associated thyroid antibodies.