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Morphological and Histochemical Changes in Muscle Biopsies of Myasthenia Gravis with Atypical Clinical Presentation

Hussam Abu Farsakh, Altaf Ijmail

Abstract


We studied the morphological and histochemical changes in muscle biopsies from six cases with myasthenia gravis (MG). The
patients were misdiagnosed at the initial presentation, however, they were all proved later by either histochmical and serological
tests or improvement on mestinone therapy. Here, we described the changes seen in muscle biopsies of MG with atypical
clinical presentation: atrophy of type II fibers, predominance of type I fibers, and increased NADH staining at the neuromuscular
junction (NMJ). The most consistent finding is a marked reduction in acetyl cholinesterase (AChE) activity at the end plates in all
cases. The results of this study suggest that histochemical and AChE stains, in combination with clinical assessment, can help
to identify unsuspected cases of MG and can help to target the appropriate clinical investigations.

Keywords


muscle biopsies, myasthenia gravis, acetyl cholinesterase receptor

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