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The clinical, serologic, and electrophysiologic features of myasthenia gravis (MG) associated with long-term use of d-penicillamine are indistinguishable from acquired autoimmune MG.1,2⇓ Most reports involve patients with rheumatoid arthritis (RA) who have underlying autoimmunity. We investigated the effect of d-penicillamine on the neuromuscular junction and the presence of acetylcholine receptor (AChR) antibody in the sera of patients with Wilson disease (WD).
Subjects and methods.
Sixty prospective patients were recruited from a large cohort of WD patients from a university hospital of south India. These patients were on d-penicillamine for at least 6 months (Group I, n = 40) or drug-naive (Group II, n = 20). d-Penicillamine was started among Group II patients, and they were re-evaluated after 6 months. Patients on drug(s) that could induce or aggravate MG were excluded.
Details regarding history and clinical features were noted. Bedside fatigability tests (ptosis, diplopia, sit-ups, arm abduction, voice fatigability) were carried out in all patients. Repetitive nerve stimulation test study …
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