• Written By: Howard Pomeranz, MD, PhD
    Neuro-Ophthalmology/Orbit

    Juvenile myasthenia gravis is pathophysiologically similar to myasthenia gravis in adults. However, a number of significant factors related to race, age at onset, severity, and antibody status complicate its management. This article reviews the clinical features of and therapeutic options for juvenile myasthenia gravis.

    This is an excellent review of myasthenia gravis management in children that highlights the treatment modalities available, including acetylcholinesterase inhibitors, thymectomy, immunosuppressive treatment with steroids, and steroid-sparing immunosuppressive agents. The article compares pediatric and adult dosing for myasthenia interventions, including pyridostigmine, prednisone, azathioprine, cyclosporine A, cyclophosphamide, mycophenolate, tacrolimus, rituximab, and intravenous immunoglobin, as well as details regarding their side effects.

    The authors conclude that the diagnosis and management of juvenile myasthenia gravis are complicated by numerous factors, and an individualized treatment plan must be chosen for each child. Outcomes improve when these patients are managed by pediatric neuromuscular experts. Only multicenter trials focused on specific subgroups are likely to establish the role of different therapies and provide the framework on which standards of treatment can be adopted.