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McCallion J, Borsi A, Noel W, Lee J, Karmous W, Sattler S, Boggia GM, Hardy EJ, Mitchell CR, Mitchell SA, Gilhus NE. Systematic review of the patient burden of generalised myasthenia gravis in Europe, the Middle East, and Africa. BMC Neurol 2024; 24:61. [PMID: 38336636 PMCID: PMC10858594 DOI: 10.1186/s12883-024-03553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is a rare autoimmune disease characterised by muscle weakness, and progression from ocular (oMG) to generalised (gMG) symptoms results in a substantial negative impact on quality of life (QoL). This systematic review aimed to provide an overview of the patient burden experienced by people living with gMG. METHODS Electronic database searches (conducted March 2022), supplemented by interrogation of grey literature, were conducted to identify studies reporting patient burden outcomes in patients with gMG in Europe, the Middle East and Africa. Results were synthesised narratively due to the heterogeneity across trials. RESULTS In total, 39 patient burden publications (representing 38 unique studies) were identified as relevant for inclusion in the systematic review, consisting of 37 publications reporting formal patient-reported outcome measures (PROMs), and two publications describing alternative qualitative assessments of patient experience. The studies included a variety of measures including generic and disease-specific PROMs, as well as symptom-specific PROMs focusing on key comorbidities including depression, anxiety, fatigue and sleep disturbance. The findings showed some variation across studies and PROMs; however, in general there was evidence for worse QoL in patients with gMG than in healthy controls or in patients with oMG, and a trend for worsening QoL with increasing MG severity. CONCLUSIONS This review highlights the importance of considering patient QoL when developing and assessing treatment and management plans for patients with gMG. However, the heterogeneity identified across studies illustrates the need for further representative and well-powered studies in large cohorts administering consistent, validated questionnaires. TRIAL REGISTRATION The protocol for this systematic review was registered in PROSPERO: CRD42022328444.
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Affiliation(s)
| | - A Borsi
- Janssen EMEA, Beerse, Belgium
| | - W Noel
- Janssen EMEA, Beerse, Belgium
| | - J Lee
- Janssen EMEA, Beerse, Belgium
| | | | | | | | - E J Hardy
- Mtech Access, Bicester, Oxfordshire, UK
| | | | | | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Jordan B, Förster L, Buchholz T, Sperfeld A, Zierz S. Personality factors in patients with myasthenia gravis: A prospective study. Brain Behav 2023; 13:e3228. [PMID: 37608592 PMCID: PMC10636423 DOI: 10.1002/brb3.3228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/05/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION In myasthenia gravis (MG), depression and anxiety have frequently been reported as comorbidities. However, little is known about personality characteristics in MG patients. We aimed to characterise personality traits in MG and to correlate them with disease severity and disease course. METHODS The Big Five Inventory data questionnaire was used to investigate personality traits in 44 MG patients and 45 healthy controls similar in age and gender. In 28 MG patients, a caregiver was also available for patient assessments to limit bias associated with social desirability in patients' responses. Patients were assessed with regard to premorbid personality (before manifestation of MG) and to present condition. In addition, anxiety and depression scales (Hospital Anxiety and Depression Scale and Beck Anxiety Inventory) were applied. RESULTS Compared to controls, MG patients showed significantly higher levels of neuroticism, whereas openness and extraversion were significantly lower. Agreeableness and conscientiousness did not differ between groups. Neuroticism was influenced by disease severity such as generalization of weakness, presence of thymoma, and bulbar involvement as well as disease duration. Neuroticism correlated with premorbid level of neuroticism but also with depression and anxiety scores. CONCLUSION A personality profile of increased neuroticism and lower openness and extraversion in MG patients may contribute considerably to the perception of disease severity. It may also be related to frequent comorbidities such as anxiety and depression. Although premorbid levels of neuroticism were increased, this characteristic may also increase considerably during the course of the disease. The data indicate that muscle weakness in MG is accompanied or even complicated by psychological aspects. Therefore, a psychological and behavioral intervention in addition to the specific pharmacological therapy might be of particular value.
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Affiliation(s)
- Berit Jordan
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle/SaaleGermany
- Department of Neurology and NeuropsychologyErnst von Bergmann Klinikum PotsdamPotsdamGermany
| | - Luise Förster
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle/SaaleGermany
- Department of PediatricsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Theresa Buchholz
- Department of Neurology, Section NeuropsychologyMartin‐Luther‐University Halle‐WittenbergHalle/SaaleGermany
| | - Anne‐Dorte Sperfeld
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle/SaaleGermany
- Department of NeurologySächsisches Krankenhaus AltscherbitzSchkeuditzGermany
| | - Stephan Zierz
- Department of NeurologyMartin‐Luther‐University Halle‐WittenbergHalle/SaaleGermany
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Li J, Wang F, Zhang C, Li Z, Gao J, Liu H. Genetically predicted effects of physical activity and sedentary behavior on myasthenia gravis: evidence from mendelian randomization study. BMC Neurol 2023; 23:299. [PMID: 37568096 PMCID: PMC10416521 DOI: 10.1186/s12883-023-03343-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction. Despite the potential benefits of higher physical activity and lower sedentary behavior in MG patients, evidence from observational studies for the effect of physical activity on the risk of MG is limited and inconclusive. METHODS We employed linkage disequilibrium score (LDSC) regression, two-sample Mendelian randomization (MR), and its multivariable extension analyses (MVMR) to assess the relationship between leisure screen time (LST), moderate-to-vigorous intensity physical activity during leisure time (MVPA) and the risk of MG using genome-wide association studies (GWAS) summary datasets. MR analyses were performed using the inverse-variance-weighted (IVW), weighted-median, and MR-Egger regression. Sensitivity analyses were further performed using alternative instruments to test the robustness of our findings. RESULTS We found evidence of genetic overlap between LST (rg = 0.113, P = 0.023) and MG, as well as between MVPA (rg=-0.220, P = 0.0001) and MG, using LDSC method. The results of the MR suggested an association between genetic liability to LST and increased risk of MG (IVW OR = 1.609, 95% CI = 1.153 to 2.244; P = 0.005). This association was particularly notable for late-onset MG (IVW OR = 1.698, 95% CI = 1.145 to 2.518; P = 0.008), but not for early-onset MG. Consistent findings were obtained in the MVMR analysis using BMI as covariate (IVW OR = 1.593, 95% CI 1.167 to 2.173, P = 0.003). However, the MR analysis does not support a substantial causal effect of MVPA on the risk of MG. CONCLUSION Our findings support a causal effect of sedentary behavior as measured by LST on MG, indicating that lack of exercise may play a role in the development of MG. Longitudinal and interventional studies of this association are warranted.
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Affiliation(s)
- Jiao Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Fei Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chen Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Zhen Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Juan Gao
- Department of Neurology, Central Hospital, Baoding No. 1, Baoding, 071000, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Sipilä JOT. Adult-Onset Neuroepidemiology in Finland: Lessons to Learn and Work to Do. J Clin Med 2023; 12:3972. [PMID: 37373667 PMCID: PMC10298930 DOI: 10.3390/jcm12123972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Finland is a relatively small genetic isolate with a genetically non-homogenous population. Available Finnish data on neuroepidemiology of adult-onset disorders are limited, and this paper describes the conclusions that can be drawn and their implications. Apparently, Finnish people have a (relatively) high risk of developing Unverricht-Lundborg disease (EPM1), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Spinal muscular atrophy, Jokela type (SMAJ) and adult-onset dystonia. On the other hand, some disorders, such as Friedreich's ataxia (FRDA) and Wilson's disease (WD), are almost absent or completely absent in the population. Valid and timely data concerning even many common disorders, such as stroke, migraine, neuropathy, Alzheimer's disease and Parkinson's disease, are unavailable, and there are virtually no data on many less-common neurological disorders, such as neurosarcoidosis or autoimmune encephalitides. There also appear to be marked regional differences in the incidence and prevalence of many diseases, suggesting that non-granular nationwide data may be misleading in many cases. Concentrated efforts to advance neuroepidemiological research in the country would be of clinical, administrative and scientific benefit, but currently, all progress is blocked by administrative and financial obstacles.
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Affiliation(s)
- Jussi O. T. Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, 80210 Joensuu, Finland;
- Clinical Neurosciences, Faculty of Medicine, University of Turku, 20014 Turku, Finland
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Gelinas D, Parvin-Nejad S, Phillips G, Cole C, Hughes T, Silvestri N, Govindarajan R, Jefferson M, Campbell J, Burnett H. The humanistic burden of myasthenia gravis: A systematic literature review. J Neurol Sci 2022; 437:120268. [DOI: 10.1016/j.jns.2022.120268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
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Billones R, Liwang JK, Butler K, Graves L, Saligan LN. Dissecting the fatigue experience: A scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain Behav Immun Health 2021; 15:100266. [PMID: 34589772 PMCID: PMC8474156 DOI: 10.1016/j.bbih.2021.100266] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Fatigue is a prevalent and potentially debilitating symptom that impacts the health-related quality-of-life of individuals diagnosed with acute and chronic medical conditions. Yet, its etiologic mechanism is not fully understood. Additionally, the assessment and determination of the clinical meaning of fatigue and its multidimensionality may vary by medical condition. Methods A scoping literature review was conducted to investigate how fatigue is defined and measured, including its dimensions, in non-oncologic medical conditions. The PubMed database was searched using keywords. Results Overall, 8376 articles were screened at the title/abstract levels, where 293 articles were chosen for full-text review that mentioned fatigue or included fatigue measures. The review of the full text excluded 246 articles that did not assess at least one fatigue dimension using validated questionnaires and clinical tests. The final set included 47 articles. Physical fatigue was the most assessed fatigue dimension and the Multidimensional Fatigue Inventory was the most widely used questionnaire to assess fatigue in this review. Limitations This review was limited by including only English-language publications and using PubMed as the sole database for the search. Conclusions This review affirms that fatigue is a multidimensional construct, agnostic of medical condition, and that individual fatigue dimensions can be measured by validated clinical measures. Future research should focus on expanding the repertoire of clinical measures to assess specific fatigue dimensions. The 27 different validated clinical measures used to assess fatigue and its dimensions; 20 instruments assessed the physical, 8 for mental, 7 cognitive, 5 for motivational, 2 for emotional, 1 peripheral, 1 for central, 1 psychosocial. Physical was the most measured dimension, as assessed in 42 of 47 included articles. This review affirms that fatigue is a multidimensional construct, agnostic of medical condition, and that individual fatigue dimensions can be measured by validate clinical measures.
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Affiliation(s)
| | | | | | | | - Leorey N. Saligan
- Corresponding author. National Institute of Nursing Research, National Institutes of Health 9000, Rockville Pike, Building 3, Room 5E14, Bethesda, MD, 20892, USA.
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Lv J, Ren L, Han S, Zhang J, Zhao X, Zhang Y, Fang H, Zhang L, Yang H, Wang S, Yang J, Cui X, Zhang Q, Zhang Y, Gao F. Peripheral blood hsa-circRNA5333-4: A novel biomarker for myasthenia gravis. Clin Immunol 2021; 224:108676. [PMID: 33465495 DOI: 10.1016/j.clim.2021.108676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
In this study, the potential of specific Circular RNAs (circRNAs) as novel peripheral blood biomarkers for myasthenia gravis (MG) was explored. We analyzed circRNAs in the peripheral blood of three normal controls and three MG patients using RNA microarray. Candidate circRNAs were validated in three independent cohorts by Quantitative Real-time polymerase chain reaction (qPCR). Eleven differentially expressed circRNAs were initially identified and four were confirmed in the first independent cohort. Hsa_circ_0076490 and hsa-circ_5333-4 had the largest areas under the curve (AUCs) of the receiver operating characteristics (ROC) and were validated in the second cohort. In the third cohort, hsa-circRNA5333-4 had a larger AUC: 0.864 (95% confidence interval [CI] = 0.801-0.928, P < 0.001), a stronger correlation with the Quantitative Myasthenia Gravis Score (qMG): r = 0.505 (P < 0.001) and was correlated with gender and acetylcholine receptor antibody levels (P < 0.05). So hsa-circRNA5333-4 represents a novel biomarker for the diagnosis and monitoring of MG.
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Affiliation(s)
- Jie Lv
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Lu Ren
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China; Department of Neurology, The First People's Hospital of Pingdingshan City, Pingdingshan, China
| | - Sensen Han
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Jing Zhang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Xue Zhao
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Yingna Zhang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Hua Fang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Linyuan Zhang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Haonan Yang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Shumin Wang
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Junhong Yang
- Department of Encephalopathy, The First Affiliated Hospital of Henan University of TCM, Zhengzhou 450008, China
| | - Xinzheng Cui
- Myasthenia gravis comprehensive diagnosis and treatment center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Qingyong Zhang
- Myasthenia gravis comprehensive diagnosis and treatment center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - Yunke Zhang
- Department of Encephalopathy, The First Affiliated Hospital of Henan University of TCM, Zhengzhou 450008, China
| | - Feng Gao
- Department of Neuroimmunology, BGI College & Henan Institute of Medical and Pharmaceutical Sciences in Academy of Medical Science, Zhengzhou University, Zhengzhou 450052, China.
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Ruiter AM, Verschuuren JJ, Tannemaat MR. Fatigue in patients with myasthenia gravis. A systematic review of the literature. Neuromuscul Disord 2020; 30:631-639. [DOI: 10.1016/j.nmd.2020.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
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Sabre L, Punga T, Punga AR. Circulating miRNAs as Potential Biomarkers in Myasthenia Gravis: Tools for Personalized Medicine. Front Immunol 2020; 11:213. [PMID: 32194544 PMCID: PMC7065262 DOI: 10.3389/fimmu.2020.00213] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease caused by antibodies which attack receptors at the neuromuscular junction. One of the main difficulties in predicting the clinical course of MG is the heterogeneity of the disease, where disease progression differs greatly depending on the subgroup that the patient is classified into. MG subgroups are classified according to: age of onset [early-onset MG (EOMG; onset ≤ 50 years) versus late-onset MG (LOMG; onset > 50 years]; the presence of a thymoma (thymoma-associated MG); antibody subtype [acetylcholine receptor antibody seropositive (AChR+) and muscle-specific tyrosine kinase antibody seropositive (MuSK+)]; as well as clinical subtypes (ocular versus generalized MG). The diagnostic tests for MG, such as antibody titers, neurophysiological tests, and objective clinical fatigue score, do not necessarily reflect disease progression. Hence, there is a great need for reliable objective biomarkers in MG to follow the disease course as well as the individualized response to therapy toward personalized medicine. In this regard, circulating microRNAs (miRNAs) have emerged as promising potential biomarkers due to their accessibility in body fluids and unique profiles in different diseases, including autoimmune disorders. Several studies on circulating miRNAs in MG subtypes have revealed specific miRNA profiles in patients’ sera. In generalized AChR+ EOMG, miR-150-5p and miR-21-5p are the most elevated miRNAs, with lower levels observed upon treatment with immunosuppression and thymectomy. In AChR+ generalized LOMG, the miR-150-5p, miR-21-5p, and miR-30e-5p levels are elevated and decrease in accordance with the clinical response after immunosuppression. In ocular MG, higher levels of miR-30e-5p discriminate patients who will later generalize from those remaining ocular. In contrast, in MuSK+ MG, the levels of the let-7 miRNA family members are elevated. Studies of circulating miRNA profiles in Lrp4 or agrin antibody-seropositive MG are still lacking. This review summarizes the present knowledge of circulating miRNAs in different subgroups of MG.
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Affiliation(s)
- Liis Sabre
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Tanel Punga
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
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Sabre L, Maddison P, Wong SH, Sadalage G, Ambrose PA, Plant GT, Punga AR. miR-30e-5p as predictor of generalization in ocular myasthenia gravis. Ann Clin Transl Neurol 2019; 6:243-251. [PMID: 30847357 PMCID: PMC6389736 DOI: 10.1002/acn3.692] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To determine a predictive factor for the risk of conversion from ocular myasthenia gravis (OMG) to generalized MG (GMG) in a prospective study. Methods RNA was isolated from serum samples and detection of microRNA (miRNA) expression analyzed with qPCR. In the discovery set, 179 human miRNAs were assayed for profiling of five OMG patients and four age‐ and gender‐matched healthy controls. Based on the specific accumulation pattern of 19 miRNAs from the discovery set, in addition to miRNAs previously found elevated in generalized MG (GMG; miR‐150‐5p and miR‐30e‐5p), 21 miRNAs were subsequently analyzed in a validation cohort of 83 OMG patients (82 immunosuppression treatment naive; 49 male) within 3 months of diagnosis and at a follow‐up visit (median duration 28 months from first visit). Results Thirteen patients generalized 14.8 ± 12.0 months after the diagnosis and the majority (85%) belonged to the late onset MG group. Two miRNAs were significantly higher in secondary GMG (SGMG) patients compared to OMG patients with late onset MG: miR‐30e‐5p (9.1 ± 0.5 vs. 6.3 ± 0.9; P < 0.0001) and miR‐150‐5p (7.4 ± 1.1 vs. 6.4 ± 1.1; P = 0.01). The sensitivity for miR‐30e‐5p in differentiating OMG and SGMG was 96% in all OMG patients and 100% in late onset OMG patients. Interpretation This is the first study to describe a potential predictive factor associated with the risk of generalization for patients with OMG. Raised levels (>8) of miR‐30e‐5p at initial presentation in patients with ocular MG symptoms, give a predictive cut‐off for subsequent generalization of 96–100%.
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Affiliation(s)
- Liis Sabre
- Department of Neuroscience Clinical Neurophysiology Uppsala University Uppsala Sweden
| | - Paul Maddison
- Department of Neurology Nottingham University Hospitals NHS Trust Queens Medical Centre Nottingham Nottinghamshire United Kingdom
| | - Sui H Wong
- Department of Neuro-ophthalmology Moorfields Eye Hospital NHS Foundation Trust London
| | - Girija Sadalage
- Department of Neurology Nottingham University Hospitals NHS Trust Queens Medical Centre Nottingham Nottinghamshire United Kingdom
| | - Philip A Ambrose
- Department of Neurology Nottingham University Hospitals NHS Trust Queens Medical Centre Nottingham Nottinghamshire United Kingdom
| | - Gordon T Plant
- Department of Neuro-ophthalmology Moorfields Eye Hospital NHS Foundation Trust London
| | - Anna R Punga
- Department of Neuroscience Clinical Neurophysiology Uppsala University Uppsala Sweden
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Westerberg E, Landtblom AM, Punga AR. Lifestyle factors and disease-specific differences in subgroups of Swedish Myasthenia Gravis. Acta Neurol Scand 2018; 138:557-565. [PMID: 30155967 DOI: 10.1111/ane.13017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate disease-specific differences between Myasthenia Gravis (MG) subgroups and compare patterns of lifestyle between MG patients and population controls. METHODS All MG patients (n = 70) in Jönköping County, Sweden, were invited to answer a disease-specific questionnaire, containing questions about disease-specific data, lifestyle, comorbidity, and mental fatigue. The patients were clinically evaluated. Four hundred age- and gender-matched population controls were invited to answer the nondisease-specific part of the questionnaire. Disease-specific issues were compared between MG subgroups. Lifestyle-related factors and concomitant conditions were compared to the population controls. RESULTS Forty MG patients and 188 population controls participated in the study. In the late-onset MG (LOMG; N = 18) subgroup, the male predominance was higher than previously reported. In the early-onset MG (EOMG; N = 17) subgroup, time to diagnosis was longer, fatigue was higher, and bulbar weakness was the dominant symptom (65%). Compared to their matched population controls, LOMG patients were more obese (OR = 13.7, P = 0.015), ate less fish (OR = 4.1, P = 0.012), tended to smoke more (OR = 4.1, P = 0.086), and tended to be employed as manual laborers more often (OR = 2.82, P = 0.083). Mental health problems and sickness benefits were more common among MG patients than in controls, and MG patients were less regularly doing focused physical activity. CONCLUSIONS It is important to consider disease-specific differences when tailoring the management of individual MG patients. There is a need for improved knowledge on how to apply primary and secondary prevention measures to lifestyle disorders in MG patients without risk of deterioration.
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Affiliation(s)
- Elisabet Westerberg
- Department of Neuroscience and Clinical Neurophysiology; Uppsala University; Uppsala Sweden
| | | | - Anna Rostedt Punga
- Department of Neuroscience and Clinical Neurophysiology; Uppsala University; Uppsala Sweden
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Farrugia ME, Di Marco M, Kersel D, Carmichael C. A Physical and Psychological Approach to Managing Fatigue in Myasthenia Gravis: A Pilot Study. J Neuromuscul Dis 2018; 5:373-385. [PMID: 29889078 DOI: 10.3233/jnd-170299] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BackgroundFatigue in myasthenia gravis (MG) is common and difficult to manage. Unlike myasthenic weakness it is not amenable to drug therapies.ObjectiveOur primary aim was to investigate whether a combination of physical and psychological therapy would help address symptoms of fatigue in MG patients, who have stable disease but residual problematic fatigue. Our secondary aim was to quantitate fatigue by applying different scores and to ascertain which would be most relevant to apply in MG.MethodsWe recruited 10 MG patients with stable disease and who suffer from fatigue. Nine of these 10 patients participated in a 10-week program that involved physical and psychological intervention. We quantified their fatigue using the modified fatigue impact scale (MFIS), the visual analogue fatigue scale (VAFS) and the fatigue severity scale (FSS) at the start of the study, at various intervals during the program and 3 months later.ResultsDuring the program, there was a small improvement in the physical and psychosocial subscale of the MFIS. There was a significant improvement (p < 0.01) in the VAFS at the end of the program. No clear improvement was noted in FSS. Three months later, all fatigue scores declined to baseline but 50% of patients had made some life-style changes.ConclusionsThis is a small pilot study, which utilized a combined approach with physical and psychological therapy, and showed some benefit in improving fatigue in patients with MG. The improvement was small and unsustained. Because of the small patient cohort, one cannot derive any firm conclusions and a larger study is required to investigate this further.
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Affiliation(s)
- Maria E Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Marina Di Marco
- Neuromuscular Physiotherapy, Clinical Genetics, West of Scotland Genetic Services, Queen Elizabeth University Hospital, Glasgow, UK
| | - Denyse Kersel
- Department of Clinical Psychology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Caroline Carmichael
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
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Fatigue in patients with myasthenia gravis. J Neurol 2018; 265:2312-2321. [DOI: 10.1007/s00415-018-8995-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
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Sabre L, Westerberg E, Liik M, Punga AR. Diversity in mental fatigue and social profile of patients with myasthenia gravis in two different Northern European countries. Brain Behav 2017; 7:e00653. [PMID: 28413704 PMCID: PMC5390836 DOI: 10.1002/brb3.653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Self-estimated health can be used for comparison of different diseases between countries. It is important to elaborate on whether disparities in self-estimated health are due to disease-specific parameters or socioeconomic differences. In this study, we aimed at evaluating clinical and social similarities and differences in myasthenia gravis (MG) patients between comparable regions in two Baltic Sea countries, Estonia and Sweden. METHODS This cross-sectional study included southern counties in Sweden and Estonia of comparable size. All patients with a confirmed MG diagnosis were asked to answer two questionnaires including demographic and disease-specific data, lifestyle issues, and mental fatigue (Fatigue Severity Scale [FSS]). Clinical fatigue was assessed objectively through the Quantitative Myasthenia Gravis Score (QMG). RESULTS Thirty-six of 92 identified patients in Estonia and 40 of 70 identified MG patients in Sweden chose to participate in the study. The demographic characteristics and symptoms reported by the patients were similar. QMG score did not differ; however, the Estonian patients scored their current subjective disease severity significantly higher (5.6 ± 2.8) compared to the Swedish patients (3.4 ± 2.3, p = .0005). Estonian patients also had significantly higher FSS scores (5.0 ± 1.7) than Swedish patients (3.5 ± 1.6; p = .001). Swedish patients were more active and performed physical activity more regularly (29.1% in Estonia and 74.2% in Sweden, p = .004). CONCLUSIONS Although, the patients had comparable clinical fatigue, Estonian patients evaluated their health state as being more severe and reported more mental fatigue than Swedish patients. These data indicate large regional differences in disease perception of MG, which is important to consider in international studies.
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Affiliation(s)
- Liis Sabre
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden.,Department of Neurology Tartu University Hospital Tartu Estonia
| | - Elisabet Westerberg
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden
| | - Maarika Liik
- Department of Neurology Tartu University Hospital Tartu Estonia
| | - Anna R Punga
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden
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