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IVIg in the chronic management of myasthenia gravis: Is it enough for your money?

  • Marinos C. Dalakas
    Correspondence
    Neuroimmunology Unit, Dept of Pathophysiology, National University of Athens Medical School, 75 Mikras Asias Str., Athens 11527, Greece. Tel.: +30 210 746 2616x2650; fax: +30 210 746 2664.
    Affiliations
    University of Athens Medical SchoolAthens, Greece
    Thomas Jefferson University, Philadelphia, PA, USA
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Published:January 13, 2014DOI:https://doi.org/10.1016/j.jns.2013.12.034
      Myasthenia gravis (MG) is a prototypic autoimmune disease because the antigen, the acetylcholine receptor (AChR), is well characterized; anti-AChR antibodies are detected in more than 85% of the patients; the serum IgG binds to AChRs at the postsynaptic region and, by fixing complement or cross-linking, causes degradation of the AChRs; the antibody response is T cell-dependent with CD4+ cells recognizing AChR epitopes; the antibodies are pathogenic, able to transfer disease to experimental animals; immunization of healthy animals with AChRs leads to clinical myasthenia that can be passed to other animals with purified IgG; and removal of the autoantibodies results in clinical improvement [
      • Dalakas M.C.
      Biologics and other novel approaches and new therapeutic options in myasthenia gravis: a view to the future.
      ,
      • Drachman D.B.
      Therapy of myasthenia gravis.
      ].
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