Fine Structural Studies in Myasthenia gravis

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Abstract
Electron microscopic studies were performed on muscle biopsy samples from 23 myasthenic patients. The fine structural changes in the neuromuscular junctions found in 7 of these cases, have been investigated. Deformations and hyperplasy of the post-synaptic apparatus were observed, as well as a reduction, or occasionally a considerable increase, in the number of postsynaptic folds. The synaptic gap was dilated at times. Increases in the amount of the basement membrane material were also recorded. Theretraction of the terminal axon was seen in advanced cases. It is suggested that the alterations of the synaptic gap may hinder or block diffusion of acetylcholine to the post-synaptic receptors. The fine structural changes lead morphologically in a very advanced stage to development of ‘intersynaptic denervation’ in the neuromuscular space. On the basis of their observations, the authors claim that in some myasthenia gravis cases there may be a correlation between the suggested autoimmune mechanism and the fine structural alterations.

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