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Ilya Kister, MD; Sandeep Gulati, MD; Cavit Boz, MD; Roberto Bergamaschi, MD; Guiseppe Piccolo, MD; Joel Oger, MD; Michael L. Swerdlow, MD

Arch Neurol. 2006;63:851-856.

Background  Myasthenia gravis (MG) and neuromyelitis optica (NMO, also known as Devic disease) are rare autoimmune disorders, with upper-limit prevalence estimates in the general population of 15 per 100 000 and 5 per 100 000, respectively. To our knowledge, an association between these diseases has not been previously reported.

Objectives  To describe 4 patients with MG who developed NMO after thymectomy and to analyze possible causes of apparent increased prevalence of NMO among patients with MG.

Design  Case series.

Patients  Four patients with MG who underwent thymectomy.

Interventions  None.

Results  The prevalence of MG within the published cohort of patients with NMO is more than 150 times higher than that in the general population.

Conclusion  Dysregulation of B-cell autoimmunity in myasthenia, possibly exacerbated by loss of control over autoreactive cells as a result of thymectomy, may predispose patients to the development of NMO.

Author Affiliations: Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY (Drs Kister and Swerdlow), and Long Island Jewish Medical Center, New Hyde Park, NY (Dr Gulati); Multiple Sclerosis Clinic, University of British Columbia, Vancouver (Drs Boz and Oger); and Multiple Sclerosis Center, Neurological Institute "C. Mondino," Pavia, Italy (Drs Bergamaschi and Piccolo).

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