A Clinical Audit of Juvenile Myasthenia Gravis at Two Academic Hospitals in Johannesburg

Abstract

Myasthenia gravis is an autoimmune disorder affecting the acetylcholine receptor leading to deficits in neuromuscular transmission across the receptor. The disorder although rare, can affect children and in which case it is termed juvenile myasthenia gravis(JMG). This study is a clinical audit to elicit the characteristics of juvenile myasthenia gravis in children diagnosed with JMG who were attending Paediatric Neurology Clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) or Chris Hani Baragwanath Academic Hospital (CHBAH). Methods This study was a retrospective audit of all patients with a diagnosis of JMG attending the paediatric neurology clinic at CMJAH or CHBAH. The files of 80 patients were reviewed for presentation, clinical findings, management and the response to treatment. Their clinical findings were classified according to the Myasthenia Gravis Foundation of America (MGFA) classification. Their remission status was also determined in relation to their clinical presentation. Results The most common clinical presentation was ocular JMG which translated to MGFA class I. There was a female gender predominance. Sixty one percent of the children who had an AChR antibody test result were seropositive. Treatment was based upon standard treatment guidelines for JMG. The remission rate was 15% with a majority of those who achieved remission being prepubertal. vii Conclusion Most of the children who were treated for JMG were prepubertal, female and MGFA classification I. The remission rate was 15%.