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Age and Ageing Advance Access originally published online on July 10, 2006
Age and Ageing 2006 35(5):542; doi:10.1093/ageing/afl040
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical Reminder

Myasthenia gravis in older patients

Sanjeevikumar Meenakshisundaram

Norfolk & Norwich University NHS Trust, Colney Lane, Norwich NR4 7UY, UK Email: sanjeevikumar{at}doctors.org.uk

We present a case of 84-year-old gentleman who presented with a history of difficulty in swallowing, especially towards the end of a big meal [1]. Functionally he was totally independent, fully self-caring and cognitively intact. On direct questioning, he admitted that there was difficulty in chewing because of fatigue on at least one occasion, but there was no history of diplopia, dysphonia and easy fatigability. Clinical examination including a thorough neurological assessment and direct laryngoscopy was normal. All invasive and non-invasive investigations were normal. Acetylcholine receptor antibody [2] was reported back to be >8 (normal being <2), and the diagnosis of myasthenia gravis was later confirmed with repetitive nerve stimulation. Myasthenia gravis is largely under-diagnosed in older population. It can present with subtle and unusual clinical pattern [3]. Anticholinesterase antibody, MuSK antibody and repetitive nerve stimulation studies can be virtually diagnostic [4, 5]. Therefore, we have to maintain a high index of suspicion in patients with subtle symptoms.


   References
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 References
 

  1. Potter J. Dysphagia in myasthenia gravis. J Laryngol Otol 1964; 78: 1053–6.[Medline]
  2. Pourmand R. Autoantibody testing. Neurol Clin 2004; 22:703–17, vii.[CrossRef][Web of Science][Medline]
  3. Wong WW, Lane RJ. Transient myasthenia gravis in an elderly woman. J Neurol Neurosurg Psychiatry 2004; 75: 1363.[Free Full Text]
  4. Vincent A, McConville J, Farrugia ME et al. Antibodies in myasthenia gravis and related disorders. Ann N Y Acad Sci 2003; 998: 324–35.[CrossRef][Web of Science][Medline]
  5. Sanders DB, El-Salem K, Massey JM, McConville J, Vincent A. Clinical aspects of MuSK antibody positive seronegative MG. Neurology 2003; 60: 1978–80.[Abstract/Free Full Text]

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