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NEUROLOGY 1989;39:1359
© 1989 American Academy of Neurology

Diagnostic significance of IgG, C3, and C9 at the limb muscle motor end-plate in minimal myasthenia gravis

M. Tsujihata, MD, T. Yoshimura, MD, A. Satoh, MD, I. Kinoshita, MD, H. Matsuo, MD, M. Mori, MD and S. Nagataki, MD

School of Allied Medical Sciences, Nagasaki University (Dr. Tsujihata)
First Department of Internal Medicine, Nagasaki University School of Medicine (Drs. Yoshimura, Satoh, Kinoshita, Matsuo, and Nagataki)
Section of Neurology, National Nagasaki Chuo Hospital, Nagasaki, Japan. (Dr. Mori)

We detected deposits of IgG, C3, and C9 (immune complexes) at the limb muscle motor end-plates (biceps brachii muscle) in 16 of 19 patients who exhibited only ocular signs and symptoms of myasthenia gravis that were improved by intravenous injections of edrophonium chloride. Circulating anti-acetylcholine receptor (anti-AChR) antibodies were negative in 6 of the 16 patients, but the motor end-plate fine structure in the postsynaptic regions was abnormal in all 16. Single-fiber EMG revealed no abnormalities in 8 of 13 patients studied. Our results indicate that the detection of immune complexes at the limb muscle end-plate provides a highly sensitive and confirmative method for diagnosing patients with minimal or atypical myasthenia gravis who have no detectable anti-AChR antibodies in their serum.

Address correspondence and reprint requests to Dr. Tsujihata, School of Allied Medical Sciences, Nagasaki University, 7-1, Sakamoto-machi, Nagasaki 852, Japan.

Received September 21, 1988. Accepted for publication in final form May 2, 1989.




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