title: Clinical characteristics of pediatric myasthenia: a surveillance study.
abstract: OBJECTIVE
  To evaluate the incidence, clinical features, diagnostic, and treatment trends of pediatric myasthenia in Canada.
  
  
  METHODS
  Through established Canadian Pediatric Surveillance Program methodology, physicians were anonymously surveyed for cases of pediatric myasthenia using a standardized clinical questionnaire containing deidentified data. Inclusion criteria were any child <18 years old with ≥1 of the following: (1) fluctuating ptosis or extraocular weakness, (2) skeletal muscle weakness or fatigue, and (3) any of the following supportive tests: clinical response to acetylcholinesterase inhibitor, positive antibodies, abnormal slow repetitive nerve stimulation, or single-fiber electromyography.
  
  
  RESULTS
  In 2 years of surveillance, 57 confirmed cases were reported. There were 34 generalized and 18 ocular reports of juvenile myasthenia gravis plus 5 congenital myasthenic syndrome cases. There were 14 incident cases in 2010 and 6 in 2011. Age of onset ranged from "birth" to 17 years for the generalized form compared with 18 months to 11 years for the ocular subtype. Positive acetylcholine receptor titers were found in 22 (67%) of 33 generalized cases and 8 (44%) of 18 ocular patients. Of patients started on pyridostigmine, improvement was noted in 33 (100%) of 33 generalized cases and 15 (88%) of 17 ocular cases.
  
  
  CONCLUSIONS
  This study represents the largest descriptive series of pediatric myasthenia in North America and provides valuable information about clinical characteristics. A high index of suspicion is important for this treatable disease. Children generally respond promptly to readily available therapies.
authors.affiliation: Department of Pediatric Neurology, University of Alberta, 3-574A ECHA 11405-87 Ave, Edmonton, AB T6G 1C9, Canada. juliana.vanderpluym@albertahealthservices.ca.
authors.forename: Juliana
authors.initials: J
authors.lastname: VanderPluym
authors.forename: Jiri
authors.initials: J
authors.lastname: Vajsar
authors.forename: Francois Dominique
authors.initials: FD
authors.lastname: Jacob
authors.forename: Jean K
authors.initials: JK
authors.lastname: Mah
authors.forename: Danielle
authors.initials: D
authors.lastname: Grenier
authors.forename: Hanna
authors.initials: H
authors.lastname: Kolski
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*
keywords: congenital myasthenic syndromes; incidence; myasthenia gravis