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Guidelines

China guidelines for the diagnosis and treatment of

myasthenia gravis

Zhu-Yi Li
Department of Neurology，Tangdu Hospital, The Fourth Military Medical University, Xi’an 710038, Shaanxi, China.

Dr. Zhu-Yi Li, Professor of Neurology
Dr. Li is the Director of Department of Neurology in Tang Du Hospital of the Fourth Military Medical University. He
graduated from the Fourth Military Medical University in 1985. He has been engaged in the prevention and treatment
of myasthenia gravis in Department of Neurosciences in University of Oxford and Case Western Reserve University.
Dr. Li is currently the Vice Chairman of Neuroimmunology branch of Chinese Society for Immunology,
Neuroimmunology Study Group of Chinese Society of Neurology, the Chairman of Chinese Society of Neurology, the
Vice Chairman of Mobile Health branch of Chinese Stroke Association, Neuroimmunology Committee of Neurology
branch of Chinese Medical Doctor Association, the Chairman of Shaanxi Neurology Association, the Associate Editor-
In-Chief of Chinese Journal of Neuroimmunology and Neurology, and the Editorial Board Member of Chinese Journal
of Neurology.
Being dedicated in researches of clinical Neurology, Dr. Li is proficient in neuroimmunology diseases such as the
prevention and treatment of myasthenia gravis. Dr. Li had 9 research projects supported by Natural Science Foundation
of China (NSFC), and 1 research project supported by Innovative Research Team Foundation of Ministry of Education.
He has published more than 200 articles, 40 of which were published in journals indexed by SCI.

Myasthenia gravis (MG) is neuromuscular gender preference is reversed after 50-year-old. At the
disorder induced neurotransmission defects at the age category of 40-50, there is no gender preference.
neuromuscular junctions. MG is an autoimmune
disease in which the autologous immune system, CLINICAL SYMPTOMS AND CLASSIFICATIONS
including the corresponding antibodies, immune
cells and complement systems, attacks the cholinergic Clinical symptoms
receptor (AChRs) of the postsynaptic membrane,
resulting in weakness of skeletal muscle. A rare Systemic skeletal muscle may be affected. However, at
portion of MG cases is mediated with antibodies the early stage of MG, there may be firstly the muscle
specific to muscle specific kinase (MuSK) and low- weakness of extraocular, throat and limbs. Seemingly,
density lipoprotein receptor related protein 4 (LRP4). the skeletal muscles innervated by the cranial nerves
The major clinical symptoms of MG are presented as are more susceptible than those innervated by spinal
weakness of skeletal muscle, fatigue prone, which are nerves. The weakness of skeletal muscles initiates
worsened after exercise. Adequate rest and treatment at a group of muscles first and gradually spreads to
with cholinesterase inhibitors could significantly other groups of muscles and eventually the whole
relieve and reduce the symptoms. The average onset system. For some patients of MG, they may rapidly
[1]
rate is about 8-20 cases per 100,000 people. MG is not experience weakness of all skeletal muscles and even
age specific but there is a higher onset rate in females myasthenic crisis.
than males at the population before 40 of age. Such
The skeletal muscle weakness of MG is volatile
with ease of fatigue, which are worsening towards
Corresponding Author: Prof. Zhu-Yi Li, Department of
Neurology, Tangdu Hospital, The Fourth Military Medical the end of the day. The weakness and fatigability is
University, No. 1 Xinsi Road, Xi’an 710038, Shaanxi, China. progressively worsening during physical activity,
E-mail: lizhuyi@fmmu.edu.cn
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Cite this article as: Li ZY. China guidelines for the diagnosis and
DOI: 10.20517/2347-8659.2015.60 treatment of myasthenia gravis. Neuroimmunol Neuroinflammation
2016;3:1-9.
Received: 03-12-2015; Accepted: 05-01-2016

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