title: [Clinical polymorphism of myasthenia gravis beginning with isolated ocular symptoms; a five years retrospective analysis].
abstract: BACKGROUND
  myasthenia gravis is a neuromuscular junction disorder that can jeopardize the patient's life and has a high clinical polymorphism that makes it difficult to diagnose.
  
  
  METHODS
  after reviewing the disease physiology, its clinical symptoms, and the different means to diagnose and treat it, we present a 15-patient series that we cared for at the Rothschild ophthalmologic foundation from 2002 to 2007 for myasthenia gravis that began with isolated ocular symptoms, so as to highlight the clinical diversity of this pathology.
  
  
  RESULTS
  when the disease was diagnosed, 11 patients out of 15 had a ptosis with diplopia, two had an isolated ptosis, and two had isolated diplopia. After investigations, we discovered that three patients had a malignant thymoma and one had thymic hyperplasia. An autoimmune disease association was found in two patients: the first one had Hashimoto thyroiditis and the second one developed optical neuromyelitis a few years after his myasthenia gravis. Only three patients secondarily developed a generalized myasthenia gravis.
  
  
  CONCLUSIONS
  our series of patients has a low disease generalization rate in comparison with the published data in the medical literature, indicating that two-thirds of patients with ocular myasthenia gravis should develop generalized myasthenia gravis within approximately 2 years after the beginning of their illness. This could be explained by the early consultation of these patients and the common prescription of an immunosuppressive therapy, reducing the risk of secondarily generalized myasthenia gravis according to some studies.
  
  
  CONCLUSIONS
  despite the small number of patients, this study underlines the clinical polymorphism of ocular myasthenia gravis and the risks it may cause. Close collaboration between ophthalmologists and neurologists is needed to ensure good care for these patients.
authors.affiliation: Service d'ophtalmologie, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France. julienboumendil@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Boumendil
authors.forename: C
authors.initials: C
authors.lastname: Clermont-Vignal
authors.forename: O
authors.initials: O
authors.lastname: Gout
authors.forename: C
authors.initials: C
authors.lastname: Fechner
authors.forename: J-L
authors.initials: JL
authors.lastname: Dufier
authors.forename: S
authors.initials: S
authors.lastname: Morax
mesh_terms: D000328:Adult; D000368:Aged; D005128:Eye Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult