Wong, SH;
(2015)
Ocular Myasthenia Gravis.
Doctoral thesis , UCL (University College London).
Abstract
Myasthenia gravis (MG) is a disorder of the neuromuscular junction, resulting in weakness of the ocular, bulbar, respiratory and limb muscles. A large proportion of patients with MG present with ocular symptoms only — typically ptosis or diplopia, termed ocular MG (OMG) if no other muscles are symptomatically involved. In a proportion of patients, weakness spreads to the limbs, bulbar or respiratory muscles, converting to generalised MG (GMG). If conversion to GMG occurs, it is usually within the first two years of disease onset. The conversion from OMG to GMG highlights a potentially significant time-point, which forms the premise of this thesis: is there a window of opportunity, where treatment can prevent conversion to GMG? It is likely that patients have different risks of conversion to GMG, but to date, there are no tests to stratify this risk. A predictive risk score will allow us to identify high-risk patients early for disease modifying treatment. With this a paradigm shift is proposed in the management of OMG: to stratify patients’ risk of GMG to better counsel them and to identify high-risk patients early. In this thesis, I present research work in creating the first predictive score for conversion to GMG within 2 years of disease onset.
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