Pediatric Autoimmune Ocular Myasthenia Gravis: Evaluation of Presentation and Treatment Outcomes in a Large Cohort

Pediatr Neurol. 2021 May:118:12-19. doi: 10.1016/j.pediatrneurol.2021.01.009. Epub 2021 Feb 5.


Background: In autoimmune myasthenia gravis (MG), autoantibodies target the neuromuscular junction. Ocular myasthenia gravis (OMG) is localized, affecting only extraocular and/or levator palpebrae muscles. OMG presents across all ages, varying in presentation, treatment modalities, and outcomes. Recently, there have been advances in MG/OMG treatment; their utilization and effectiveness are an important part of optimal disease management.

Methods: We completed a retrospective chart review of children aged 18 years or younger with a confirmed diagnosis of OMG presenting from 2002 to 2019.

Results: Forty-two patients were included with mean age at presentation of 8.5 years (2 to 18 years). Twenty-one patients (50%) had positive antibodies; 90% had acetylcholine receptor antibodies. Ten patients developed generalized symptoms with mean time to generalization of 13.6 months. Multiple logistic regression showed that older age of onset was a trend predictive factor (P = 0.054; odds ratio 1.17) for generalized disease. All patients were treated with pyridostigmine. Immunomodulating agents included steroids (15), mycophenolate mofetil (four), and intravenous immunoglobulin (one). Three patients underwent thymectomy. Twenty patients reached minimal manifestation status, and 12 achieved remission. Gender, race, and positive antibody status were not statistically significant predictors for advanced immunosuppressive therapy.

Conclusions: We summarize one of the largest cohorts of pediatric patients with OMG who have undergone up-to-date diagnostic and therapeutic regimens. The predictors of outcome and treatment pathway for OMG patients suggested by this report may be further elucidated by future prospective studies.

Keywords: Myasthenia gravis; Neuromuscular disease; Ocular myasthenia gravis; Ophthalmoplegiae; Pediatric; Ptosis.

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Cholinesterase Inhibitors / therapeutic use
  • Disease Progression
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Male
  • Myasthenia Gravis / complications
  • Myasthenia Gravis / diagnosis*
  • Myasthenia Gravis / therapy*
  • Prednisone / therapeutic use
  • Pyridostigmine Bromide / therapeutic use
  • Retrospective Studies
  • Treatment Outcome


  • Cholinesterase Inhibitors
  • Glucocorticoids
  • Immunosuppressive Agents
  • Pyridostigmine Bromide
  • Prednisone