Late-onset myasthenia gravis - A changing scene

The prevalence of myasthenia gravis (MG) among middle-aged and older patien ts has increased. Patients with early-onset MG live longer than before, but there is also an increase in late-onset MG (onset of the disease after the age of 50 years in patients with no clinical or paraclinical evidence of a thymoma). Epidemiological data support using the age of 50 years to separa te early- and late-onset MG. The main immunological difference between earl y- and late-onset MG is the presence of antibodies to muscle titin, which a re detected in approximately 50% of patients with late-onset MG. Treatment of late-onset MG has to be tailored both to the age of the patient and to t he immunological findings of that particular form of MG.