the pathophysiology of MG is much more complicated then it seems. it is very far from being the best understood autoimmune disease, and autoimmunity is not well understood in general.

we tend to think of autoimmune disease as one abnormal antibody, causing one problem, but in reality this is probably not the case. any immune process is polyclonal and not monoclonal (unless it is a rare type of cancer, in which there is over-production of one single antibody).

further more, any immune process involves both antibody producing cells and other immune cells, that "work" together to eliminate the invading pathogen. (this is what the immune system is basically meant for).

our tests are very limited in the antibodies they can detect. this does not mean that there aren't others that we just don't test for.

what caused the immune system to recognize self as non-self, is a major unsolved question, but it probably has to do with some (probably genetic) abnormalities , either in protein related to the immune system (mainly those involved in recognition of antigens), or in proteins related to the "attacked" cells.

this is one of the concerns with vaccines. as they lead to a relatively less controlled activation of the immune system, and may cause on-going immune dysregulation in patients who are prone to that. a relatively rare. but real complication.

I am not aware of any information regarding subsets of patients that do not respond to rituximab. overall there is very sparse data regarding this treatment in MG. I am not aware of any study (double blind or even open lable) that assessed this mode of treatment in MG.

I would not be too attracted to the idea of rebuilding your immune system. it sounds very romantic, but in reality it means a week or more of hospitalization in isolation. and a fairly long recovery to what you were before. with a significant infectious risk for more then a year, and possibly even more in someone who has had a thymectomy.

so your neuro's reluctance to do that, sounds very reasonable to me.

hope this helps and is not just more confusing,

alice