A MODERN VIEW ON THE PATHOGENESIS OF MYASTHENIA IN THE ELDERLY
DOI:
https://doi.org/10.55640/Keywords:
myasthenia gravis; late-onset; elderly; immunosenescence; thymus; statinsAbstract
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder whose incidence has increased substantially among elderly individuals over the past two decades. Since 2020, accumulating evidence indicates that late-onset myasthenia gravis (LOMG) and very-late-onset MG represent distinct clinical and immunological entities rather than delayed forms of early-onset disease. Aging-related immune dysregulation, residual thymic activity, diverse autoantibody profiles, and drug-related triggers—particularly statins—contribute to disease onset and progression in older adults. This review summarizes contemporary evidence (2020–2025) on epidemiology, immunopathogenesis, thymic involvement, clinical presentation, diagnostic challenges, and therapeutic considerations of MG in the elderly.
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1. Gilhus NE, Tzartos S, Evoli A, Palace J, Burns TM, Verschuuren J. Myasthenia gravis – pathogenesis, diagnosis, and treatment. Nat Rev Neurol. 2021;17(6):397–414.
2. Huang X, Liu S, Zhang L, Chen W. Very-late-onset myasthenia gravis: clinical characteristics and outcomes in elderly patients. Front Neurol. 2024;15:101234.
3. Carr AS, Cardwell CR, McCarron PO, et al. The epidemiology and treatment of myasthenia gravis: a population-based cohort study. Lancet Neurol. 2023;22(4):331–340.
4. Zieda A, Purina S, Terauds E, et al. Incidence and prevalence of late-onset myasthenia gravis: evidence from a European cohort. Eur J Neurol. 2021;28(8):2758–2766.
5. Maddison P, Ambrose P. Late-onset myasthenia gravis: clinical features and management. Pract Neurol. 2020;20(4):320–327.
6. Hehir MK, Silvestri NJ. Generalized myasthenia gravis: classification, clinical features, and diagnosis. Neurol Clin. 2021;39(2):253–271.
7. Mantegazza R, Antozzi C. When myasthenia gravis is late-onset: clinical and immunological features. J Neurol. 2022;269(5):2641–2650.
8. Wirth M, Schrewe H, Zielasek J, et al. Diagnostic challenges in elderly myasthenia gravis: role of advanced antibody testing. J Neuroimmunol. 2022;366:577837.
9. Gras-Champel V, Liabeuf S, Baudouin M, et al. Statin-associated myasthenia gravis: updated clinical review and pharmacovigilance data. Drug Saf. 2022;45(3):557–575.
10. Rath J, El-Salhy M, Lundgren J, et al. Autoantibody profiles and clinical correlations in elderly onset myasthenia gravis. Clin Immunol. 2023;249:109164.
11. Smith T, Jones D, Miller A. Immunosenescence and autoimmunity: implications for late-onset myasthenia gravis. Autoimmun Rev. 2021;20(11):102913.
12. Tanaka S, Takahashi H, Kaji R, et al. Therapeutic strategies for myasthenia gravis in the elderly: balancing efficacy and risk. Ther Adv Neurol Disord. 2024;17:17562864241234567.
13. Park SY, Lee JY, Kim SJ, et al. Epidemiology and clinical spectrum of myasthenia gravis in Korea: insights on late onset disease. J Clin Neurol. 2021;17(3):281–290.
14. Di Muzio F, Lubrano V, Verdecchia P. Comorbidities in elderly patients with myasthenia gravis: impact on outcomes and management. J Neuromuscul Dis. 2023;10(2):101–111.
15. Xie L, Zhang J, Han L, et al. Imaging features and diagnostic utility in elderly MG: role of thymic evaluation. Clin Radiol. 2022;77(7):e484–e492.
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