PURPOSE OF REVIEW: Myasthenic disorders are a well characterized group of 
diseases of the neuromuscular junction. Their pathogenesis is diverse, including 
genetic and autoimmune mechanisms. We review recent findings on risk factors, 
pathogenesis and treatment of autoimmune myasthenia gravis.
RECENT FINDINGS: Better knowledge of congenital myasthenia has led to the 
development of efficient diagnostic algorithms that have therapeutic 
implications. New epidemiological and genetic risk factors have been identified 
and are considered to play a role in the development of myasthenia gravis. The 
study of the role of innate immunity in myasthenia gravis has identified 
relevant pathways to explain myasthenia gravis causes. The description of the 
pathogenic role of IgG4 anti-MuSK antibodies has revealed heterogeneous immune 
mechanisms that should lead to more specific therapies. Rituximab seems to be 
particularly effective in MuSK myasthenia gravis, and eculizumab arises as an 
option in refractory AChR myasthenia gravis. Therapeutic algorithms need to be 
tailored to each myasthenia subtype.
SUMMARY: Increasing knowledge about the environmental and genetic risk factors 
and basic immunopathogenesis of myasthenia gravis, including the role of innate 
immunity, regulatory T cell impairment and autoantibody heterogeneity, is 
providing a rationale for treatment with new biological agents. Current 
immunotherapies in myasthenia gravis undoubtedly provide benefits, but also 
cause side-effects. Controlled trials are, therefore, needed to confirm initial 
results from pilot studies.