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Myasthenia Gravis

SPEP abnormality and MG

02/20/2006

Question:

I was diagnosed with MG in 1998 and recently had a serum protein electrophoresis {SPEP} test. This revealed a slightly elevated M-spike. I read that this can occur due to an autoimmune disease as well as numerous other causes. I am undergoing testing to try to determine the cause of the M-spike. Are you aware of patients with MG also having an abnormal SPEP where the cause is simply having MG? Many thanks.

Answer:

This is a very interesting question. As you know, myasthenia is an autoimmune disease caused by an abnormal antibody to the acetylcholine receptor. These antibodies, theoretically, if in high enough concentrations, could represent the M spike on a serum protein electrophoresis (SPEP). I found a great article about Waldenstrom's, a disease with an abnormal protein M spike, and myasthenia. There are very few documented cases, but there is definitely at least an association. These protein spikes may have derived from the antibodies underlying the autoimmune disease, but they also might be just associated. How this correlates with treatment and monitoring of disease is unclear. A search for other diseases associated with the M spike should be performed. The article citation is below: Myasthenia gravis and Waldenstrom's macroglobulinemia: a case report and review of the literature. Acta Neurol Scand. 2001 Oct;104(4):246-8.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati