Myasthenia Gravis

With great admiration for the talented contributors to this issue of Seminars in Neurology, I offer the following introductory comments. Myasthenia gravis (MG) is just common enough that it touches the practice of every neurologist. While the classic textbook patient is rarely a challenge from the diagnostic standpoint, such patients can become incredibly complicated when searching through the state-of-the-art options for medical and surgical management. Beyond those patients who have a straightforward diagnosis there are all of those in whom the diagnosis itself is a struggle. And for each one of those there are another 10 patients in whom MG enters into the differential diagnosis. MG is still “the neurologist's disease,” as emphasized by my old boss T.R. Johns. MG still requires a balance of knowledge, experience, common sense, and a heavy tincture of the art of medicine to optimally manage our patients. The neurologist, as is often the case, is at the center of a multi-disciplinary effort in caring for a patient with MG who is in the throws of immunosuppressive treatment (the internist), surgery (thymectomy), anesthesiology, and their primary care team. The neurologist is typically in the best position to teach our colleagues about the disease and its management.

In looking through the last issue of Seminars dedicated to disorders of neuromuscular transmission over a decade ago (the topic is revisited by Seminars about every 10 years), the growth of knowledge and evolution of management is such that it behooves us to visit the topic once again. A decade back there were very few who would predict that we would have MuSK, mycophenylate, or sophisticated treatment for malignant thymoma. The old reviews contained little information for the neurologist regarding perioperative care, anesthesia issues for thymectomy, or a detailed discussion of crisis.

This issue taps the expertise and writing skills of numerous experts in the field. Most of them require no introduction to an audience of neurologists. The goal of this program is to provide the clinician with a concise and focused review of practical clinical aspects of MG and related disorders. The current collection represents topics bonded to myasthenia gravis. The second collection (in the next issue of Seminars, Volume 24, Number 2) contains topics dealing with other disorders of neuromuscular transmission (such as Lambert-Eaton Syndrome and botulism). We hope to favorably affect the care received by patients by providing the clinician with a thorough and comprehensive discussion of the practical issues surrounding clinical diagnosis and management.

ACKNOWLEDGMENTS The authors deserve all the credit for taking the time to prepare such superb and timely reviews. These are people I admire professionally and personally. The staff of Seminars in Neurology should be thanked for their first-rate professional work on the project. Mr. David Stewart is a splendid and talented individual who somehow gets everything accomplished properly and within a palatable schedule. The current Editor in Chief continues to serve as a wonderful conductor of this orchestra-getting all of these star players to play the concert in tune and at the same time. Karen Roos has certainly proven those correct who speculated that she would advance the state of editorial work over the former Editor in Chief. Karen and I are terribly grateful to Linda Hagan for her expertise, her patience, and her hard work. She is vital to the success of this journal.