Special populations in myasthenia gravis: Early, late, and very late-onset MG.

Abstract

The age at disease onset significantly influences the clinical course, pathophysiology, and treatment response in Myasthenia Gravis (MG). This chapter examines how immunological profiles, autoantibody prevalence, thymic pathology, genetic associations, treatment responses, and disease severity vary across early-onset (EOMG), late-onset (LOMG), and very late-onset MG (VLOMG). EOMG often presents with distinct immunological and genetic profiles, a predominance of female patients, and a higher incidence of thymic hyperplasia. In contrast, LOMG and VLOMG are characterized by thymic atrophy, differing genetic associations, and milder long-term disease courses with variable treatment responses. Recognizing these age-related variations is essential for optimizing diagnostic approaches and therapeutic strategies, highlighting the need for individualized patient management across different age groups.