Clinical aspects of neuromuscular transmission disorders.
Autoimmune disorders of neuromuscular transmission are caused by antibodies (abs) directed against membrane proteins at the motor end-plate. Myasthenia gravis (MG) is due, in most cases, to abs against the nicotinic acetylcholine receptor (AChR). Anti-AChR-positive MG actually includes different disease entities: weakness can be confined to extrinsic ocular muscles or can be generalized; patients with generalized MG (G-MG) can be subdivided on the basis of age of onset, HLA association and thymic pathology. About 15% of G-MG patients are anti-AChR-negative; in a proportion of these cases serum abs against the muscle- specific kinase (MuSK) are found. Anti-MuSK-positive MG is characterized by predominant involvement of bulbar muscles and very low frequency of thymic pathology. The Lambert-Eaton myasthenic syndrome (LEMS) is caused by abs against voltage-gated calcium channels at nerve terminal. LEMS is characterized by muscle weakness and autonomic disturbances and it is paraneoplastic in over 50% of the cases. In neuromyotonia and cramp-fasciculation syndrome, that are thought to be due to anti-voltage-gated potassium channel abs, signs of peripheral nerve hyperexcitability can be associated with CNS features.
Evoli
Amelia
A
Neuroscience Department, Catholic University, Roma, Italy. a.evoli@rm.unicatt.it
D006801:Humans; D020386:Isaacs Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015624:Lambert-Eaton Myasthenic Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy