Ocular myasthenia gravis in a senior population: diagnosis, therapy, and prognosis

The objectives of this study were (I) to explore the prognosis of ocular myasthenia gravis (OMG) in patients with onset at age 70 years and above (i.e. senior persons); (2) to identify predictors of secondary generalization in this age group; and 3) to address the effects of immunotherapy on this population of patients. We performed a retrospective analysis of 39 patients with myasthenia gravis who presented with only ocular signs and symptoms after age 70 years. Generalized myasthenia gravis (GMG) developed in 12 OMG patients (31%). None of the GMG patients required ventilator assistance or a feeding tube. Of the 12 ocular patients progressing to GMG, only one (8%) received immunotherapy prior to generalization. Of those OMG patients who did not progress to GMG, 52% received immunomodulatory therapy. Our senior OMG patients had a prognosis comparable with those of the published data for younger individuals. Although the presence of increased acetylceholine receptor antibody titers and occasionally abnormal repetitive nerve stimulation were useful tools to diagnose OMG, no test was predictive of later generalization. Senior onset OMG patients who received immunotherapy less frequently developed GMG than those not so treated.