Guillain-Barré syndrome with autoimmune hemolytic anemia following acute viral hepatitis

A patient with Guillain-Barré syndrome associated with autoimmune hemolytic anemia following post-transfusional acute viral HBsAg- positive hepatitis improved dramatically and subsequently recovered from both diseases after plasmapheresis and steroid therapy. This case supports an autoimmune mechanism of Guillain-Barré syndrome.

Short and long-term clinical effects of plasma-exchange in 33 cases of myasthenia gravis

The authors examine the results of plasma exchange (PE) treatment in 33 patients with myasthenia gravis, who underwent a total of 49 cycles of treatment. On the basis of clinical response, evaluated in relation to a modification of the functional state and to the duration of improvement after PE, we selected a group of 20 responsive patients ("responders" = 60.6%) and 13 non-responsive patients ("non-responders" = 39.4%). Positive effects, some only short-lasting, were observed in 24 patients (72.7%) after 32 cycles of a total of 49 cycles (65.3%). Out of the 11 most critical patients, 7 (63.6%) were considered responders, given the importance and duration of the improvement they presented, while 2 other patients had clear but short-lasting improvements; in these 9 patients, the positive effects amounted to 81.2%. Factors presumably responsible for therapeutic failure in the non-responders are discussed.

Electroencephalographic findings in patients with chronic progressive external ophthalmoplegia

A retrospective study of the electroencephalographic patterns in 26 adults with chronic progressive external ophthalmoplegia. 12 of them presented EEG anomalies, all slight and aspecific. Of the various parameters considered (age, age at onset, duration of disease, CT, CSF findings, abnormalities of muscle mitochondria) the only two that seem to correlate are altered EEG patterns and severity of mitochondrial anomalies in skeletal muscle tissue.

Intrathecal methylprednisolone acetate in multiple sclerosis treatment. Clinical evaluation

Twenty-eight patients with clinically definite Multiple Sclerosis were treated with intrathecal injections of Methylprednisolone acetate, 40 mg at four days intervals. Kurtzke's Disability Status Scale was evaluated in all the patients together with sum of scores for the neurological functions and the subjective assessment, before and after the treatment. Ten Multiple Sclerosis patients, treated with prednisone (100 mg at alternate days) were taken as a control group. No real advantages were found with the intrathecal treatment as compared to the orally administered steroids.

Lymphocyte populations in patients with myasthenia gravis. Influence of thymectomy and immunosuppressive drugs

The T/B peripheral blood lymphocyte ratio was evaluated in 51 patients with myasthenia gravis by means of the rosette test and HTLA. Total T cells and T gamma and Tmu were decreased while B lymphocytes were increased. E-active rosettes were also above the normal range. The previous thymectomy and/or immunosuppressive treatment restored the T lymphocytes identified by HTLA to normal range while those identified by E rosettes were still reduced. This difference may be due to the different stages of T lymphocyte maturation.

EEG findings in 118 cases of myasthenia gravis

We examined 148 EEG recordings from 118 patients affected with myasthenia gravis (35 males and 83 females, aged 17-82, with illness durations between 1 month and 24 years). The cases were clinically evaluated according to Ossermann's classification at the time of EEG recording. EEG patterns were subdivided into normal, diffuse or focal slow abnormalities, or epileptiform patterns. Of the 118 patients, 104 had normal EEG recordings and 14 had at least one abnormal recording (8 diffuse slow abnormalities, 6 focal slow abnormalities). The EEG findings were not correlated with clinical parameters (thymic pathology, respiratory incidents, drug treatment, etc.). One patient (whose EEG recordings were normal) showed an isolated epileptic fit and another patient was affected by epilepsy. A possible relationship between the two diseases is discussed.

Antibody-induced degradation of acetylcholine receptor in myasthenia gravis: clinical correlates and pathogenetic significance

Sera of myasthenic patients containing anti-AChR antibodies increase the rate of degradation of mammalian AChR. This phenomenon, antigenic modulation (AMd), was tested on AChR of rat myotubes in serum from 48 myasthenic patients. Sixty-six percent of the sera increased AChR degradation. AMd activity was higher in more severely affected patients, paralleled clinical evolution in individual patients, and was related to AChR-antibody titer. Steroid treatment and thymectomy did not affect AMd activity. Patients who had a thymoma always had greater AMd activity.

A case of progressive external ophthalmoplegia (Kiloh-Nevin type) with abnormal mitochondria. Clinical, histochemical and ultrastructural findings

A case of progressive external ophthalmoplegia is described, in which the onset of the illness was at 28--30 years, with fatigability and muscular pains in the lower limbs as presenting symptoms. At 36--37 years weakness of the mimic muscles also appeared and fatigability and muscular pains spread to the upper limbs: EMG examination showed signs of light myopathic involvement of the shoulder-girdle muscles, so that a muscular biopsy was performed (right deltoid). Histoenzymologic studies showed the presence of generally atrophic dark fibres, which can be brought about to red-ragged fibres. Ultrastructural study showed bizarrely shaped mitochondria, with dense matrix and circular and confluent cristae, which were found in fibres with plenty of indifferent sarcoplasm and with anomalies in myofibrils. No mitochondrial inclusions were seen.