{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:41:19Z","timestamp":1774435279369,"version":"3.50.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>Juvenile myasthenia gravis (JMG) is an antibody-mediated autoimmune disorder of the neuromuscular junction, at the postsynaptic end plate. JMG presents with fluctuating skeletal muscle weakness and fatigue before the age of 18 years. Very frequently JMG presents with the involvement of the oculomotor muscles, with or without generalized involvement.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We performed a retrospective chart review of patients diagnosed with myasthenia in the pediatric neuromuscular clinics at UT Southwestern, between 1990 and 2010. Osserman classification and the response to therapy scale of Millichap and Dodge were used to compare each patient's severity of myasthenia and responsiveness to drugs before the surgery as a baseline and at the last visit, after thymectomy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Fifty-eight patients were included; 29 (50%) were African American, and 34 (58.6%) were female. Age of onset was 11 months to 17 years, and 38 patients (65%) presented as generalized myasthenia gravis. Forty-nine patients (84%) were acetylcholine receptor antibody (AchR-Ab) positive. Of the 32 to undergo thymectomy, 19 subjects (59%) experienced an improved response to B level on the Myasthenia Scale of Millichap and Dodge (good improvement, both objective and subjective, but continuation of drug therapy required in the same or lower dosage) and 75% experienced a drop in Osserman classification by at least 1. Of the 8 individuals who did not show improvement after thymectomy, 4 subjects (50%) underwent repeat thymectomy. They had initially less invasive fluoroscopic or thoracoscopic procedure. Thymic hyperplasia was found in 7 patients (21%) and thymoma in 2.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Thymectomy was well tolerated by this group of children. There was clinical improvement after thymectomy in two thirds of the AchR-Ab\u2013positive generalized myasthenia gravis patients. Thymic pathology was seen in less than one third of the patients who underwent thymectomy, with thymic hyperplasia being common. Further studies are necessary to determine whether thymectomy is indicated for all children with generalized JMG. More information about the immunologic, genetic, and molecular differences between patients may determine the best treatment for individual patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/cnd.0b013e318253a48e","type":"journal-article","created":{"date-parts":[[2013,3,22]],"date-time":"2013-03-22T18:01:02Z","timestamp":1363975262000},"page":"95-102","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":61,"title":["Juvenile Myasthenia Gravis"],"prefix":"10.1097","volume":"14","author":[{"given":"Diana","family":"Castro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir","family":"Derisavifard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Medrith","family":"Greene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Iannaccone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-1-20240808","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1471-2377-10-46","article-title":". A systematic review of population based epidemiological studies in myasthenia gravis.","volume":"10","author":"Carr","year":"2010","journal-title":"BMC Neurol"},{"key":"R2-1-20240808","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1196\/annals.1254.053","article-title":"The epidemiology of myasthenia gravis.","volume":"998","author":"Phillips","year":"2003","journal-title":"Ann NY Acad Sci"},{"key":"R3-1-20240808","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/BF01959485","article-title":". Early-onset myasthenia gravis: clinical characteristics and response to therapy.","volume":"150","author":"Batocchi","year":"1990","journal-title":"Eur J Pediatr"},{"key":"R4-1-20240808","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1002\/mus.21195","article-title":"Juvenile myasthenia gravis.","volume":"39","author":"Chiang","year":"2009","journal-title":"Muscle Nerve"},{"key":"R5-1-20240808","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/mus.20950","article-title":". Lifetime course of myasthenia gravis.","volume":"37","author":"Grob","year":"2008","journal-title":"Muscle Nerve"},{"key":"R6-1-20240808","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1212\/WNL.44.7.1208","article-title":". Race, sex, and puberty influence onset, severity, and outcome in juvenile myasthenia gravis.","volume":"44","author":"Andrews","year":"1994","journal-title":"Neurology"},{"key":"R7-1-20240808","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1177\/0883073808325651","article-title":"Juvenile myasthenia gravis: three case reports and a literature review.","volume":"24","author":"Gadient","year":"2009","journal-title":"J Child Neurol"},{"key":"R8-1-20240808","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1177\/088307380201700516","article-title":". Gender prevalence in childhood multiple sclerosis and myasthenia gravis.","volume":"17","author":"Haliloglu","year":"2002","journal-title":"J Child Neurol"},{"key":"R9-1-20240808","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/S0960-8966(98)00077-7","article-title":". Juvenile myasthenia gravis with prepubertal onset.","volume":"8","author":"Evoli","year":"1998","journal-title":"Neuromuscul Disord"},{"key":"R10-1-20240808","doi-asserted-by":"crossref","first-page":"202","DOI":"10.2350\/09-07-0672-OA.1","article-title":". Thymoma in children: report of 2 cases and review of the literature.","volume":"13","author":"Liang","year":"2010","journal-title":"Pediatr Dev Pathol"},{"key":"R11-1-20240808","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s004150050135","article-title":"Outcome in juvenile-onset myasthenia gravis: a retrospective study with long-term follow-up of 79 patients.","volume":"244","author":"Lindner","year":"1997","journal-title":"J Neurol"},{"key":"R12-1-20240808","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S1474-4422(09)70063-8","article-title":"Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity.","volume":"8","author":"Meriggioli","year":"2009","journal-title":"Lancet Neurol"},{"key":"R13-1-20240808","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/ana.410130506","article-title":". Myasthenia gravis in children: long-term follow-up.","volume":"13","author":"Rodriguez","year":"1983","journal-title":"Ann Neurol"},{"key":"R14-1-20240808","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S0161-6420(99)00138-4","article-title":". The natural history and ophthalmic involvement in childhood myasthenia gravis at the Hospital for Sick Children.","volume":"107","author":"Mullaney","year":"2000","journal-title":"Ophthalmology"},{"key":"R15-1-20240808","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1600-0404.2006.00646.x","article-title":". Myasthenia gravis in children: a longitudinal study.","volume":"114","author":"Ashraf","year":"2006","journal-title":"Acta Neurol Scand"},{"key":"R16-1-20240808","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.ejcts.2006.06.009","article-title":". Complete stable remission after extended trans sternal thymectomy in myasthenia gravis.","volume":"30","author":"Park","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"key":"R17-1-20240808","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/j.1749-6632.1998.tb11010.x","article-title":"Thymectomy in childhood myasthenia gravis.","volume":"841","author":"Seybold","year":"1998","journal-title":"Ann NY Acad Sci"},{"key":"R18-1-20240808","first-page":"497","article-title":". Studies in myasthenia gravis: review of twenty- year experience in over 1200 patiets.","volume":"38","author":"Osserman","year":"1971","journal-title":"Mt Sinai J Med"},{"key":"R19-1-20240808","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1212\/WNL.10.11.1007","article-title":"Diagnosis and treatment of myasthenia gravis in infancy, childhood, and adolescence.","volume":"10","author":"Millichap","year":"1960","journal-title":"Neurology"}],"container-title":["Journal of Clinical Neuromuscular Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00131402-201303000-00001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T19:26:45Z","timestamp":1723145205000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00131402-201303000-00001"}},"subtitle":["A Twenty-Year Experience"],"short-title":[],"issued":{"date-parts":[[2013,3]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.1097\/cnd.0b013e318253a48e","relation":{},"ISSN":["1522-0443"],"issn-type":[{"value":"1522-0443","type":"print"}],"subject":[],"published":{"date-parts":[[2013,3]]}}}