Myasthenia gravis
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Embargo End Date
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Authors
Abstract
The thesis is 72 publications describing the author's hypothesis
of an autoimmune basis for myasthenia gravis (MG) and its validation.
At the time of the first 24 papers many considered that MG was a
syndrome rather than a disease entity, due to a biochemical disorder
of the neuromuscular junction. Favoured models were a circulating
"curare-like" substance released from the thymus gland, or a pre¬
junctional abnormality, possibly causing release of small quanta of
acetylcholine at the motor nerve terminals. Endplate receptor
substance was speculative. The immunological role of the thymus was
unknown and autoimmunity was a new concept in medicine. The
therapeutic value of thymectomy was controversial.
The controversy about thymectomy was resolved (papers 2,3) by reanalysing data separately for patients with a thymoma and the conclusions have proved definitive. Papers based on the cases reviewed in that survey led to an autoimmune hypothesis with a thymic disorder causing production of antibodies with loss of tolerance to self-tissue, mainly but not exclusively at the motor endplates of muscle. The first recognition of many associated diseases and a reinterpretation of the relationship with thyroid disorders are described, with the first evidence for a genetic predilection with alternative expression.
During the 35 years of this work the distinct nature of "carcinomatous" myasthenia has been identified, and the nonimmunological congenital myasthenias defined by other workers. A personal series of observational and theoretical papers argued against the contemporary views on the neuromuscular disorder in favour of blockade and/or damage of the putative acetylcholine receptors (AChR) at the neuromuscular junction by antibody. In the 1970s, recognition of oC -bungarotoxin as a ligand for the AChR enabled identification by other workers of the proposed antibodies and their attack site on the recently identified endplate receptors. Antibody raised against electroplaque tissue (with high concentration of AChR) caused a myasthenic model in experimental animals, supporting the proximate mechanism of my model. With colleagues (acknowledged in text) I have investigated the polyclonal nature of the immunological disorder of MG and in the final papers (submitted for publication) review evidence that MG is a limited manifestation of systemic lupus erythematosus. Clinical studies on the possible role of steroid hormones on insertion of new receptors in the post synaptic membrane had to be abandoned when I retired from medical practice.
(1) Walton JN, Geschwind N, Simpson JA Benign congenital myopathy with myasthenic features. J Neurol Neurosurg Psychiat 1956;19:224-31. | (2) Simpson JA. The value of thymectomy. Proc R Soc Med 1957;49:795-98. | (3) Simpson JA. An evaluation of thymectomy in myasthenia gravis. Brain 1958;81:112-44. | (4) Simpson JA. Myasthenia gravis: a new hypothesis. Scott Med J 1960;5:419-36. | (5) Simpson JA. The differential diagnosis and management of crisis in myasthenia gravis with notes on the use of oximes in the treatment of cholinergic crises. Communications to the British Pharmacological Society and to the Scottish Society of Physicians, 1961. | (6) Simpson JA. Myasthenia gravis and autoimmunity. (Letter). Brit Med J 1962;ii:1130. | (7) Simpson JA. Carcinomatous myasthenia. (Letter). Brit Med J 1962;ii:1329. | (8) Simpson JA. Myasthenia gravis. Nursing Times 1963:36-8, 67-8. | (9) Simpson JA. Immunological disturbances in myasthenia gravis with a report of Hashimoto's disease developing after thymectomy. J Neurol Neurosurg Psychiat 1964;27:485-92. | (10) Simpson JA. Autoimmunity in myasthenia gravis. 8th International Congress of Neurology, Vienna. Excerpta Medica International Congress Series 94, Abstract 187 and communication, 1965. | (11) Simpson JA. Psychological aspects of myasthenia gravis. Communication to the Royal Medico-Psychological Association, 1965. | (12) Simpson JA. Myasthenia gravis. In: Cumings JN, Kremer M (eds) Biochemical Aspects of Neurological Disorders. 2nd ser. Oxford: Blackwell, 1965:53-72. | (13) Simpson JA. Myasthenia gravis as an autoimmune disease: clinical aspects. Ann NY Acad Sci 1966;135:506-16. | (14) Simpson JA. Disorders of neuromuscular transmission. Proc R Soc Med 1966;59:983-98. | (15) Simpson JA. The biochemistry of myasthenia gravis. In: Kuhn E (ed) Progressive Muskeldystrophie, Myotonie, Myasthenie. Heidelberg:Springer-Verlag, 1966:339-49. | (16) Simpson JA. Myasthenia gravis and myasthenic syndromes. In: Walton JN (ed) Disorders of Voluntary Muscle, Editions 1-4. Edinburgh: Churchill-Livingstone, 1964-1981. | (17) Simpson JA. Myasthenia gravis and the anaesthetist. Guest Lecture to the Scottish Society of Anaesthetists. (Summary). 1967. | (18) Simpson JA. Myasthenia gravis - the present position. Communication to The Thoracic Society 1968. | (19) Simpson JA. Myasthenia gravis; clinical aspects. Proc R Soc Med 1968;61:757-59. | (20) Simpson JA. The correlations between myasthenia gravis and disorders of the thyroid gland. In Research in Muscular Dystrophy. Proceedings of the 4th Symposium. London: Pitman, 1968:31-41. | (21) Simpson JA. The defect in myasthenia gravis. In: Bittar EE, Bittar N (eds) The Biological Basis of Medicine. Vol 3. London and New York: Academic Press, 1969:345-87. | (22) Vetters JM, Simpson JA, Folkarde A. Experimental myasthenia gravis. Lancet 1969;ii:28-31. | (23) Simpson JA. Myasthenia gravis. In: Walton JN, Canal N, Scarlato G (eds) Muscle Diseases. Excerpta Medica International Congress Series 199, 1969:14-22. | (24) Simpson JA. The drug treatment of myasthenia gravis. Prescribers1 Journal 1971;11:9-14. | (25) Simpson JA. Pathogenesis of myasthenia gravis. (Letter). Brit Med J 1971;ii:276. | (26) Simpson JA. A morphological explanation of the transmission defect in myasthenia gravis. Ann NY Acad Sci 1971;183:241-47. | (27) Simpson JA. Myasthenia. In: Bouchier IAD (ed) Seventh Symposium on Advanced Medicine, Royal College of Physicians of London, London: Pitman, 1971:141-50. | (28) Simpson JA. Myasthenia gravis; the effects of pregnancy and menstruation. Proceedings of 2nd International Congress of Muscle Diseases, Perth, Australia. Excerpta Medica International Congress Series 237, Abstract 54, 1971. | (29) Vetters JM, Saikia NK, Wood J, Simpson JA. Pemphigus vulgaris and myasthenia gravis. Brit J Dermatol 1973;88:437-41. | (30) Simpson JA. Myasthenia gravis and myasthenic syndromes. Proceedings of 10th International Congress of Neurology, Barcelona. Excerpta Medica International Congress Series 296, Abstract 41, 1973. | (31) Simpson JA, Vetters JM. Histological assessment of the myasthenic thymus gland and the response to thymectomy. Proceedings of 10th International Congress of Neurology, Barcelona. Excerpta Medica International Congress Series 296, Abstract 259, 1973. | (32) Vetters JM, Simpson JA. Comparison of thymic histology with response to thymectomy in myasthenia gravis. J Neurol Neurosurg Psychiat 1974;37:1139-45. | (33) Behan PO, Simpson JA, Dick H. Immune response genes in myasthenia gravis. (Letter). Lancet 1973;ii:1033. | (34) Dick HM, Behan PO, Simpson JA, Durward WF. The inheritance of HL-A antigens in myasthenia gravis. J Immunogenetics 1974;1:401-12. | (35) Simpson JA. Tolleranza immunologics e miastenia: il ruolo del timo nell'accrescimento e nella differenziazione. Riv Pat Nerv Ment (Firenze) 1974;95:376-88. | (36) Simpson JA. Weather and myasthenic fatigue. (Letter) Lancet 1974;ii:458. | (37) Simpson JA. Myasthenia gravis and myasthenic syndromes. In: Subarina A, Burrows JM (eds) Neurology, Proceedings of 10th International Congress of Neurology. Excerpta Medica International Congress Series 319, 1974:399-411. | (38) Behan WMH, Behan PO, Simpson JA. Absence of cellular hypersensitivity to muscle and thymic antigens in myasthenia gravis. J Neurol Neurosurg Psychiat 1975;38:1039-47. | (39) Sandilands GP, Gray K, Cooney A, Anderson JR, Simpson JA, Behan PO. Rosette tests following thymectomy. (Letter) Lancet 1975;i:171-2. | (40) Behan PO, Simpson JA, Behan WMH. Decreased serum-IgA in myasthenia gravis. (Letter) Lancet 1976;i:593-4. | (41) Simpson JA, Behan PO, Dick HM. Studies on the nature of autoimmunity in myasthenia gravis. Evidence for an immunodeficiency type. Ann NY Acad Sci 1976;274:382-9. | (42) Simpson JA. Current status of therapeutics in myasthenia gravis. Invited review, Symposium on Current Problems in Myasthenia Gravis. Istituto Neurologico 'C.Besta', Milan, 1976. | (43) Rees D, Behan PO, Behan WH, Simpson JA. Myasthenia gravis: passive transfer from man to mouse. Seventh Symposium on Current Research in Muscular Dystrophy, Birmingham. Muscular Dystrophy Group of Great Britain, (Abstract), 1977. | (44) Simpson JA. Myasthenia gravis - validation of a hypothesis. The Joan Vincent Memorial Lecture to the Muscular Dystrophy Group of Gt. Britain. Scott Med J 1977;22:201-10. | (45) Simpson JA. Myasthenia gravis: a clinical approach to pathogenesis. In: Lunt GG, Marchbanks RM (eds) The Biochemistry of Myasthenia Gravis and Muscular Dystrophy, London: Academic Press, 1978:77-87. | (46) Simpson JA. Myasthenia gravis: a personal view of pathogenesis and mechanism. Parts 1 and 2. Muscle & Nerve 1978;1:45-56 and 151-6. | (47) Fraser K, Simpson JA, Crawford J. The place of surgery in the treatment of myasthenia gravis. Brit J Surg 1978;65:301-4. | (48) Simpson JA. Principles of treatment of myasthenia gravis. In: Aguayo AJ, Karpati G (eds) Current Topics in Nerve and Muscle Research, Excerpta Medica International Congress Series 455, 1979:133-40. | (49) Simpson JA. Myasthenia gravis: treatment principles. Guidelines to the Neurosciences 1979;3(1):2-4. | (50) Behan P0, Shakir RA, Simpson JA, Burnett AK, Allan TL, Haase G. Plasma exchange combined with immunosuppressive therapy in myasthenia gravis. Lancet 1979;ii:438-40. | (51) Barkas T, Harrison R, Limt GG, Stephenson FA, Behan PO, Simpson JA. Acetylcholine receptor antibody titres in myasthenia gravis. In: Behan PO, Rose FC (eds) Progress in Neurological Research, Turibridge Wells: Pitman Medical, 1979:169-74. | (52) Carter B, Harrison R, Lunt GG, Behan PO, Simpson JA. Antiacetylcholine receptor antibody titres in the sera of myasthenia patients treated with plasma exchange combined with immunosuppressive therapy. J Neurol Neurosurg Psychiat 1980;43:397-402. | (53) Simpson JA. Myasthenia gravis. (The Chandy Oration 1980, to the Neurological Society of India.) Neurology, India 1981;29:45-50. | (54) Simpson JA. Clinical constraints to pathogenesis models of myasthenia gravis. In: Satoyoshi E (ed) Myasthenia Gravis, Pathogenesis and Treatment. Japan Medical Research Foundation, Tokyo: University of Tokyo Press, 1981:29-37. | (55) Simpson JA. The thymus in the pathogenesis and treatment of myasthenia gravis. In: Satoyoshi E (ed) Myasthenia Gravis, Pathogensis and Treatment. Japan Medical Research Foundation, Tokyo: University of Tokyo Press, Tokyo, 1981:301-7. | (56) Simpson JA. Pathogenesis and treatment of myasthenia gravis. (Letter) Brit Med J 1981;283:1332. | (57) Simpson JA. Myasthenia gravis. The Practitioner 1982;226:1045- 50. | (58) Barkas T, Simpson JA. Experimental myasthenia gravis is inhibited by receptor-antibody complexes. J Clin Lab Immunol 1982;7:223-7. | (59) Barkas T, Simpson JA. Lack of inter-animal cross-reaction of anti-acetylcholine receptor antibodies at the receptor-binding site as demonstrated by heterologous anti-idiotype antisera: implications for immunotherapy of myasthenia gravis. Clin exp Immunol 1982;47:119-26. | (60) Barkas T, Gairns JM, Kerr HJ, Coggins JR, Simpson JA. -Bungarotoxin binding to the nicotinic acetylcholine receptor is inhibted by two distinct subpopulations of anti-receptor antibodies. Eur J Immunol 1982;12:757-61. | (61) Barkas T, Simpson JA. -Bungarotoxin displacing antibody in myasthenia gravis. J Clin Lab Immunol 1982;9:113-17. | (62) Simpson JA. Myasthenia gravis - 1982. Invited review, 5th International Congress of Neuromuscular Diseases, Marseilles, 1982. | (63) Simpson JA. The myasthenic (Eaton-Lambert) syndrome associated with carcinoma. Enzyme induction as a possible mechanism of paraneoplastic syndromes. Scott Med J 1982;27:220-28. | (64) Simpson JA. Current concepts and history of the autoimmune nature of myasthenia gravis. In: Albuquereque EX, Eldefrawi AT (eds) Myasthenia Gravis. London and New York: Chapman Hall, 1983:3-41. | (65) Simpson JA. Neonatal myasthenia gravis. Leeds Symposium on Immunology and Pregnancy: Myasthenia Gravis in the Pregnant Woman and the Neonate. Brit Assoc Immunol 1983. | (66) Simpson JA. The acute problems of myasthenia gravis. In: Beattie AD, Ireland JT (eds) Emergencies in Medicine. London: Pitman, 1984:196-203. | (67) Simpson JA. Myasthenia gravis - past, present and future. The Janet Reid Lecture to the Royal College of Physicians of Edinburgh. In: Symposium on Neurology 1984, Royal College of Physicians of Edinburgh 1984:62-71. | (68) Vasquez R, Simpson JA, Stimson WH, Doyle D. Monoclonal antibody to human acetylcholine receptor; B cell hybrids established from thymus of mice with experimental autoimmune myasthenia gravis. Brit Assoc Immunol, Abstract 8, 1984. | (69) Simpson JA, Thomaides T Treatment of myasthenia gravis: an audit. Quart J Med 1987;NS64:693-704. | (70) Simpson JA. Myasthenia gravis and related syndromes. In: Walton Sir John (ed) Disorders of Voluntary Muscle, 5th ed. Edinburgh:Churchill-Livingstone, 1988:628-65. | (71) Simpson JA. Myasthenia gravis in pregnancy. (Submitted for publication.) | (72) Simpson JA. Recurrent intrauterine death associated with the anti-cardiolipin antibody in myasthenia gravis. (Submitted for publication.)
The controversy about thymectomy was resolved (papers 2,3) by reanalysing data separately for patients with a thymoma and the conclusions have proved definitive. Papers based on the cases reviewed in that survey led to an autoimmune hypothesis with a thymic disorder causing production of antibodies with loss of tolerance to self-tissue, mainly but not exclusively at the motor endplates of muscle. The first recognition of many associated diseases and a reinterpretation of the relationship with thyroid disorders are described, with the first evidence for a genetic predilection with alternative expression.
During the 35 years of this work the distinct nature of "carcinomatous" myasthenia has been identified, and the nonimmunological congenital myasthenias defined by other workers. A personal series of observational and theoretical papers argued against the contemporary views on the neuromuscular disorder in favour of blockade and/or damage of the putative acetylcholine receptors (AChR) at the neuromuscular junction by antibody. In the 1970s, recognition of oC -bungarotoxin as a ligand for the AChR enabled identification by other workers of the proposed antibodies and their attack site on the recently identified endplate receptors. Antibody raised against electroplaque tissue (with high concentration of AChR) caused a myasthenic model in experimental animals, supporting the proximate mechanism of my model. With colleagues (acknowledged in text) I have investigated the polyclonal nature of the immunological disorder of MG and in the final papers (submitted for publication) review evidence that MG is a limited manifestation of systemic lupus erythematosus. Clinical studies on the possible role of steroid hormones on insertion of new receptors in the post synaptic membrane had to be abandoned when I retired from medical practice.
(1) Walton JN, Geschwind N, Simpson JA Benign congenital myopathy with myasthenic features. J Neurol Neurosurg Psychiat 1956;19:224-31. | (2) Simpson JA. The value of thymectomy. Proc R Soc Med 1957;49:795-98. | (3) Simpson JA. An evaluation of thymectomy in myasthenia gravis. Brain 1958;81:112-44. | (4) Simpson JA. Myasthenia gravis: a new hypothesis. Scott Med J 1960;5:419-36. | (5) Simpson JA. The differential diagnosis and management of crisis in myasthenia gravis with notes on the use of oximes in the treatment of cholinergic crises. Communications to the British Pharmacological Society and to the Scottish Society of Physicians, 1961. | (6) Simpson JA. Myasthenia gravis and autoimmunity. (Letter). Brit Med J 1962;ii:1130. | (7) Simpson JA. Carcinomatous myasthenia. (Letter). Brit Med J 1962;ii:1329. | (8) Simpson JA. Myasthenia gravis. Nursing Times 1963:36-8, 67-8. | (9) Simpson JA. Immunological disturbances in myasthenia gravis with a report of Hashimoto's disease developing after thymectomy. J Neurol Neurosurg Psychiat 1964;27:485-92. | (10) Simpson JA. Autoimmunity in myasthenia gravis. 8th International Congress of Neurology, Vienna. Excerpta Medica International Congress Series 94, Abstract 187 and communication, 1965. | (11) Simpson JA. Psychological aspects of myasthenia gravis. Communication to the Royal Medico-Psychological Association, 1965. | (12) Simpson JA. Myasthenia gravis. In: Cumings JN, Kremer M (eds) Biochemical Aspects of Neurological Disorders. 2nd ser. Oxford: Blackwell, 1965:53-72. | (13) Simpson JA. Myasthenia gravis as an autoimmune disease: clinical aspects. Ann NY Acad Sci 1966;135:506-16. | (14) Simpson JA. Disorders of neuromuscular transmission. Proc R Soc Med 1966;59:983-98. | (15) Simpson JA. The biochemistry of myasthenia gravis. In: Kuhn E (ed) Progressive Muskeldystrophie, Myotonie, Myasthenie. Heidelberg:Springer-Verlag, 1966:339-49. | (16) Simpson JA. Myasthenia gravis and myasthenic syndromes. In: Walton JN (ed) Disorders of Voluntary Muscle, Editions 1-4. Edinburgh: Churchill-Livingstone, 1964-1981. | (17) Simpson JA. Myasthenia gravis and the anaesthetist. Guest Lecture to the Scottish Society of Anaesthetists. (Summary). 1967. | (18) Simpson JA. Myasthenia gravis - the present position. Communication to The Thoracic Society 1968. | (19) Simpson JA. Myasthenia gravis; clinical aspects. Proc R Soc Med 1968;61:757-59. | (20) Simpson JA. The correlations between myasthenia gravis and disorders of the thyroid gland. In Research in Muscular Dystrophy. Proceedings of the 4th Symposium. London: Pitman, 1968:31-41. | (21) Simpson JA. The defect in myasthenia gravis. In: Bittar EE, Bittar N (eds) The Biological Basis of Medicine. Vol 3. London and New York: Academic Press, 1969:345-87. | (22) Vetters JM, Simpson JA, Folkarde A. Experimental myasthenia gravis. Lancet 1969;ii:28-31. | (23) Simpson JA. Myasthenia gravis. In: Walton JN, Canal N, Scarlato G (eds) Muscle Diseases. Excerpta Medica International Congress Series 199, 1969:14-22. | (24) Simpson JA. The drug treatment of myasthenia gravis. Prescribers1 Journal 1971;11:9-14. | (25) Simpson JA. Pathogenesis of myasthenia gravis. (Letter). Brit Med J 1971;ii:276. | (26) Simpson JA. A morphological explanation of the transmission defect in myasthenia gravis. Ann NY Acad Sci 1971;183:241-47. | (27) Simpson JA. Myasthenia. In: Bouchier IAD (ed) Seventh Symposium on Advanced Medicine, Royal College of Physicians of London, London: Pitman, 1971:141-50. | (28) Simpson JA. Myasthenia gravis; the effects of pregnancy and menstruation. Proceedings of 2nd International Congress of Muscle Diseases, Perth, Australia. Excerpta Medica International Congress Series 237, Abstract 54, 1971. | (29) Vetters JM, Saikia NK, Wood J, Simpson JA. Pemphigus vulgaris and myasthenia gravis. Brit J Dermatol 1973;88:437-41. | (30) Simpson JA. Myasthenia gravis and myasthenic syndromes. Proceedings of 10th International Congress of Neurology, Barcelona. Excerpta Medica International Congress Series 296, Abstract 41, 1973. | (31) Simpson JA, Vetters JM. Histological assessment of the myasthenic thymus gland and the response to thymectomy. Proceedings of 10th International Congress of Neurology, Barcelona. Excerpta Medica International Congress Series 296, Abstract 259, 1973. | (32) Vetters JM, Simpson JA. Comparison of thymic histology with response to thymectomy in myasthenia gravis. J Neurol Neurosurg Psychiat 1974;37:1139-45. | (33) Behan PO, Simpson JA, Dick H. Immune response genes in myasthenia gravis. (Letter). Lancet 1973;ii:1033. | (34) Dick HM, Behan PO, Simpson JA, Durward WF. The inheritance of HL-A antigens in myasthenia gravis. J Immunogenetics 1974;1:401-12. | (35) Simpson JA. Tolleranza immunologics e miastenia: il ruolo del timo nell'accrescimento e nella differenziazione. Riv Pat Nerv Ment (Firenze) 1974;95:376-88. | (36) Simpson JA. Weather and myasthenic fatigue. (Letter) Lancet 1974;ii:458. | (37) Simpson JA. Myasthenia gravis and myasthenic syndromes. In: Subarina A, Burrows JM (eds) Neurology, Proceedings of 10th International Congress of Neurology. Excerpta Medica International Congress Series 319, 1974:399-411. | (38) Behan WMH, Behan PO, Simpson JA. Absence of cellular hypersensitivity to muscle and thymic antigens in myasthenia gravis. J Neurol Neurosurg Psychiat 1975;38:1039-47. | (39) Sandilands GP, Gray K, Cooney A, Anderson JR, Simpson JA, Behan PO. Rosette tests following thymectomy. (Letter) Lancet 1975;i:171-2. | (40) Behan PO, Simpson JA, Behan WMH. Decreased serum-IgA in myasthenia gravis. (Letter) Lancet 1976;i:593-4. | (41) Simpson JA, Behan PO, Dick HM. Studies on the nature of autoimmunity in myasthenia gravis. Evidence for an immunodeficiency type. Ann NY Acad Sci 1976;274:382-9. | (42) Simpson JA. Current status of therapeutics in myasthenia gravis. Invited review, Symposium on Current Problems in Myasthenia Gravis. Istituto Neurologico 'C.Besta', Milan, 1976. | (43) Rees D, Behan PO, Behan WH, Simpson JA. Myasthenia gravis: passive transfer from man to mouse. Seventh Symposium on Current Research in Muscular Dystrophy, Birmingham. Muscular Dystrophy Group of Great Britain, (Abstract), 1977. | (44) Simpson JA. Myasthenia gravis - validation of a hypothesis. The Joan Vincent Memorial Lecture to the Muscular Dystrophy Group of Gt. Britain. Scott Med J 1977;22:201-10. | (45) Simpson JA. Myasthenia gravis: a clinical approach to pathogenesis. In: Lunt GG, Marchbanks RM (eds) The Biochemistry of Myasthenia Gravis and Muscular Dystrophy, London: Academic Press, 1978:77-87. | (46) Simpson JA. Myasthenia gravis: a personal view of pathogenesis and mechanism. Parts 1 and 2. Muscle & Nerve 1978;1:45-56 and 151-6. | (47) Fraser K, Simpson JA, Crawford J. The place of surgery in the treatment of myasthenia gravis. Brit J Surg 1978;65:301-4. | (48) Simpson JA. Principles of treatment of myasthenia gravis. In: Aguayo AJ, Karpati G (eds) Current Topics in Nerve and Muscle Research, Excerpta Medica International Congress Series 455, 1979:133-40. | (49) Simpson JA. Myasthenia gravis: treatment principles. Guidelines to the Neurosciences 1979;3(1):2-4. | (50) Behan P0, Shakir RA, Simpson JA, Burnett AK, Allan TL, Haase G. Plasma exchange combined with immunosuppressive therapy in myasthenia gravis. Lancet 1979;ii:438-40. | (51) Barkas T, Harrison R, Limt GG, Stephenson FA, Behan PO, Simpson JA. Acetylcholine receptor antibody titres in myasthenia gravis. In: Behan PO, Rose FC (eds) Progress in Neurological Research, Turibridge Wells: Pitman Medical, 1979:169-74. | (52) Carter B, Harrison R, Lunt GG, Behan PO, Simpson JA. Antiacetylcholine receptor antibody titres in the sera of myasthenia patients treated with plasma exchange combined with immunosuppressive therapy. J Neurol Neurosurg Psychiat 1980;43:397-402. | (53) Simpson JA. Myasthenia gravis. (The Chandy Oration 1980, to the Neurological Society of India.) Neurology, India 1981;29:45-50. | (54) Simpson JA. Clinical constraints to pathogenesis models of myasthenia gravis. In: Satoyoshi E (ed) Myasthenia Gravis, Pathogenesis and Treatment. Japan Medical Research Foundation, Tokyo: University of Tokyo Press, 1981:29-37. | (55) Simpson JA. The thymus in the pathogenesis and treatment of myasthenia gravis. In: Satoyoshi E (ed) Myasthenia Gravis, Pathogensis and Treatment. Japan Medical Research Foundation, Tokyo: University of Tokyo Press, Tokyo, 1981:301-7. | (56) Simpson JA. Pathogenesis and treatment of myasthenia gravis. (Letter) Brit Med J 1981;283:1332. | (57) Simpson JA. Myasthenia gravis. The Practitioner 1982;226:1045- 50. | (58) Barkas T, Simpson JA. Experimental myasthenia gravis is inhibited by receptor-antibody complexes. J Clin Lab Immunol 1982;7:223-7. | (59) Barkas T, Simpson JA. Lack of inter-animal cross-reaction of anti-acetylcholine receptor antibodies at the receptor-binding site as demonstrated by heterologous anti-idiotype antisera: implications for immunotherapy of myasthenia gravis. Clin exp Immunol 1982;47:119-26. | (60) Barkas T, Gairns JM, Kerr HJ, Coggins JR, Simpson JA. -Bungarotoxin binding to the nicotinic acetylcholine receptor is inhibted by two distinct subpopulations of anti-receptor antibodies. Eur J Immunol 1982;12:757-61. | (61) Barkas T, Simpson JA. -Bungarotoxin displacing antibody in myasthenia gravis. J Clin Lab Immunol 1982;9:113-17. | (62) Simpson JA. Myasthenia gravis - 1982. Invited review, 5th International Congress of Neuromuscular Diseases, Marseilles, 1982. | (63) Simpson JA. The myasthenic (Eaton-Lambert) syndrome associated with carcinoma. Enzyme induction as a possible mechanism of paraneoplastic syndromes. Scott Med J 1982;27:220-28. | (64) Simpson JA. Current concepts and history of the autoimmune nature of myasthenia gravis. In: Albuquereque EX, Eldefrawi AT (eds) Myasthenia Gravis. London and New York: Chapman Hall, 1983:3-41. | (65) Simpson JA. Neonatal myasthenia gravis. Leeds Symposium on Immunology and Pregnancy: Myasthenia Gravis in the Pregnant Woman and the Neonate. Brit Assoc Immunol 1983. | (66) Simpson JA. The acute problems of myasthenia gravis. In: Beattie AD, Ireland JT (eds) Emergencies in Medicine. London: Pitman, 1984:196-203. | (67) Simpson JA. Myasthenia gravis - past, present and future. The Janet Reid Lecture to the Royal College of Physicians of Edinburgh. In: Symposium on Neurology 1984, Royal College of Physicians of Edinburgh 1984:62-71. | (68) Vasquez R, Simpson JA, Stimson WH, Doyle D. Monoclonal antibody to human acetylcholine receptor; B cell hybrids established from thymus of mice with experimental autoimmune myasthenia gravis. Brit Assoc Immunol, Abstract 8, 1984. | (69) Simpson JA, Thomaides T Treatment of myasthenia gravis: an audit. Quart J Med 1987;NS64:693-704. | (70) Simpson JA. Myasthenia gravis and related syndromes. In: Walton Sir John (ed) Disorders of Voluntary Muscle, 5th ed. Edinburgh:Churchill-Livingstone, 1988:628-65. | (71) Simpson JA. Myasthenia gravis in pregnancy. (Submitted for publication.) | (72) Simpson JA. Recurrent intrauterine death associated with the anti-cardiolipin antibody in myasthenia gravis. (Submitted for publication.)
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