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Topics:
Neurology • Neuromuscular
When do you test for myasthenia antibodies beyond AChR and MuSK?
Answer from: at Community Practice
I always check an LRP4 antibody. This is helpful to prognosticate and to determine specific treatments. For example, MuSK Ab (+) MG, as an IgG4 mediated disorder, responds particularly well to B cell therapies and FcRn treatments, but since IgG4 poorly activates complement, a complement inhibitor wo...
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Answer from: at Community Practice
Like the majority of neurological diseases, myasthenia gravis is a clinical diagnosis. Personally, I do not rely on serology. As a neuro-ophthalmologist, I see many ocular and generalized Myasthenic patients with both positive and negative serology. I typically rely on a good history and ocular exam...
Answer from: at Community Practice
I agree. Also, it's good to know the type of assay used for the AChR testing as cell-based assays can be positive in close to 50% of seronegative patients tested using traditional assay (RIA).
Answer from: at Community Practice
The yield on LRP4 antibodies is very low and I reserve for those who are AChR and MuSK negative.