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Lu M, Reisch J, Iannaccone S, Batley K. Juvenile Myasthenia Gravis in North Texas: Clinical Features, Treatment Response, and Outcomes. Pediatr Neurol 2024; 156:10-14. [PMID: 38688232 DOI: 10.1016/j.pediatrneurol.2024.03.019] [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: 09/22/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Juvenile myasthenia gravis (JMG) is a rare autoimmune disease that causes fatigable muscle weakness in children aged <18 years. There is currently no curative treatment or internationally accepted standard of care for JMG. The objective is to investigate relationships between clinical presentation, antibody status, severity of disease onset, electrodiagnostic evaluation, and response to therapy in JMG. METHODS This study was a retrospective chart review. Congenital myasthenic syndromes were excluded. Data on demographics, treatments, and outcomes were collected. Disease severity was evaluated using Myasthenia Gravis Foundation of America (MGFA) clinical classifications. RESULTS We identified 84 patients with JMG at Children's Medical Center Dallas between January 2014 and February 2022. It was found that 52% of patients presented with ocular JMG (median onset age 4.5 years) and 48% with generalized JMG (median onset age 11.5 years); 81% tested positive for acetylcholine receptor antibodies. Patients were 17% non-Hispanic white, 29% Hispanic, 39% black, and 12% Asian. There was a significant difference in average MGFA scores between ethnicities (P = 0.047) and age groups (P = 0.004), with postpubertal patients having higher average MGFA scores than prepubertal patients. Seventy-one percent of patients who underwent thymectomy experienced a decrease in MGFA scores postprocedure. CONCLUSIONS Our study showed that there were significant differences in disease severity between ethnicities and age groups and that most patients who underwent thymectomy showed clinical improvement. These outcomes highlight the need for additional therapies in the treatment of JMG and the importance of extending clinical trials to the pediatric population.
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Affiliation(s)
- Marilyn Lu
- Pediatric Neuromuscular Division, Departments of Pediatrics and Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Joan Reisch
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Susan Iannaccone
- Pediatric Neuromuscular Division, Departments of Pediatrics and Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kaitlin Batley
- Pediatric Neuromuscular Division, Departments of Pediatrics and Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas
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Rodrigues E, Umeh E, Aishwarya, Navaratnarajah N, Cole A, Moy K. Incidence and prevalence of myasthenia gravis in the United States: A claims-based analysis. Muscle Nerve 2024; 69:166-171. [PMID: 38040629 DOI: 10.1002/mus.28006] [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: 03/31/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION/AIMS Myasthenia gravis (MG) is a rare neuromuscular disorder with geographically variable prevalence and incidence rates. A global trend of increasing prevalence of MG has been observed in the last few decades, and this study aimed to assess the current prevalence and incidence rates of MG in the United States. METHODS Data were extracted from the Clarivate Real-World Data Repository (2016-2021), a US claims and electronic health records database. The prevalence and incidence of MG were calculated for the year 2021 for males and females who were <2, 2-5, 6-11, 12-17, 18-49, 50-64, and ≥65 years of age, using population estimates from the US Census. RESULTS The diagnosed prevalence and incidence of MG in the United States in 2021 were calculated to be 37.0 per 100,000 persons and 3.1 per 100,000 persons, respectively. While the incidence and prevalence of MG increased with age in both men and women, higher prevalence and incidence of MG were observed in younger women (<50 years) compared with men of matching age, and in older men (≥65 years) compared with women of the same age group. DISCUSSION The updated prevalence and incidence of MG in the United States in 2021 are higher than previous reports from the 1980s and early 2000s, following a global trend of increased prevalence and incidence for this disorder in the last few decades.
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Affiliation(s)
- Ema Rodrigues
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | - Emeka Umeh
- Clarivate Analytics, Boston, Massachusetts, USA
| | - Aishwarya
- Clarivate Analytics, Bangalore, Karnataka, India
| | | | - Alexander Cole
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | - Kristin Moy
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
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Vinciguerra C, Bevilacqua L, Lupica A, Ginanneschi F, Piscosquito G, Rini N, Rossi A, Barone P, Brighina F, Di Stefano V. Diagnosis and Management of Seronegative Myasthenia Gravis: Lights and Shadows. Brain Sci 2023; 13:1286. [PMID: 37759888 PMCID: PMC10526522 DOI: 10.3390/brainsci13091286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Myasthenia gravis (MG) is an antibody-mediated neuromuscular disease affecting the neuromuscular junction. In most cases, autoantibodies can be detected in the sera of MG patients, thus aiding in diagnosis and allowing for early screening. However, there is a small proportion of patients who have no detectable auto-antibodies, a condition termed "seronegative MG" (SnMG). Several factors contribute to this, including laboratory test inaccuracies, decreased antibody production, immunosuppressive therapy, immunodeficiencies, antigen depletion, and immune-senescence. The diagnosis of SnMG is more challenging and is based on clinical features and neurophysiological tests. The early identification of these patients is needed in order to ensure early treatment and prevent complications. This narrative review aims to examine the latest updates on SnMG, defining the clinical characteristics of affected patients, diagnostic methods, management, and therapeutic scenarios.
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Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Antonino Lupica
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (F.G.)
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Nicasio Rini
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (F.G.)
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84131 Salerno, Italy; (C.V.)
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy (V.D.S.)
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Hughes T, Anderson AEL, Habib AA, Perez K, Bergin C, Suchotliff S, Zvosec C, McDaniel D, Sato M, Whangbo A, Phillips G. Impact of social determinants of health on individuals living with generalized myasthenia gravis and implications for patient support programs. Front Public Health 2023; 11:1147489. [PMID: 37275500 PMCID: PMC10235801 DOI: 10.3389/fpubh.2023.1147489] [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: 01/18/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Social determinants of health (SDOH) are important contributors to health outcomes, and better understanding their impact on individuals diagnosed with rare, chronic diseases with high burden and unmet need is critical. Characterizing SDOH burden can help improve the design of patient support programs (PSPs), using targeted approaches to remove barriers to access. Methods This study used a mixed-methods strategy employing a quantitative survey, which was designed based on qualitative interviews, to understand the unmet needs and awareness/utilization of PSPs among individuals living with generalized myasthenia gravis (gMG) and experiencing SDOH barriers. The survey was completed by 38 individuals living with gMG, of which the majority were non-White/Caucasian, unemployed, low income, and enrolled in public insurance. Common SDOH challenges, awareness/utilization of available PSPs, and unmet needs were identified. Results Financial and mental health concerns were the most common among individuals living with gMG and experiencing SDOH barriers throughout diagnosis, accessing treatment, initiating treatment, and continuing treatment. Awareness and utilization of existing support services were low, especially when accessing treatment. Educational, financial, and personalized support with high "human touch" were commonly perceived as the most valuable resources. Implications To better serve the needs of individuals with gMG experiencing SDOH barriers, PSPs should use a targeted approach to offer services tailored to harder-to-reach populations. Further, providers, advocacy groups, manufacturers, and public organizations in the gMG ecosystem should strengthen collaborations with PSPs to enable individuals living with gMG to access the services they need to improve their health outcomes.
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Affiliation(s)
- Tom Hughes
- argenx US Inc., Boston, MA, United States
| | | | - Ali A. Habib
- UCI Health ALS & Neuromuscular Center, University of California Irvine, Orange, CA, United States
| | | | | | | | | | | | - Mai Sato
- ZS Associates, New York, NY, United States
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LOMPO DL, Éric SOME N, OUEDRAOGO AM, YONLI RP, DIALLO O, NAPON C, MILLOGO A, KABORE J. [Clinical and paraclinical profile of autoimmune myasthenia gravis in Ouagadougou, Burkina Faso]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsi.2021.169. [PMID: 35685858 PMCID: PMC9128415 DOI: 10.48327/mtsi.2021.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Certain differences in the epidemiological, clinical, paraclinical and evolution profiles of autoimmune myasthenia gravis (AIMG) are increasingly described in patients according to geographic origins. The present study was carried out in order to help characterize the socio-demographic, clinical and paraclinical profile of AIMG in Ouagadougou, Burkina Faso. PATIENTS AND METHODS This was a cross-sectional, descriptive, multicenter, hospital study carried out in Ouagadougou (Burkina Faso), over a period of 5 years 6 months, from March 2015 to September 2019. The study concerned all patients who had a clinical symptomatology suggestive of myasthenia gravis, associated with the presence in the serum of anti-AChR Ab and / or anti-MuSK Ab and / or the presence of a >10% decrement in electroneuromyography and / or a positive therapeutic test for oral anticholinestherasics. Sociodemographic, clinical and paraclinical variables, were analyzed. RESULTS A total of 25 patients (15 women and 10 men), were included. The young adult form was predominant (20 cases). The median time between the first symptoms and the diagnosis was 28.4 months +/- 44.8 (2 - 217 months). Diplopia and/or ptosis (80%) and dysphonia (72%) were the most frequent revealing clinical presentations. On admission, 7 patients (28%) had a moderate generalized form (MGFA class III) and 9 patients (36%) had a severe to very severe generalized form (MGFA class IV to V). Plasma Ab assays were performed in 17 patients (68%): anti-RACh Ab were positive in 11 patients (64.7%) and anti-MuSK Ab in 3 patients (14.3%). Thoracic CT revealed thymus hyperplasia in 12 patients (48%), thymoma in 5 patients (20%). Hyperthyroidism was associated in 2 patients (8%). CONCLUSION AIMG in Ouagadougou, Burkina Faso is marked by delayed diagnosis, a predominance in young women, severe generalized forms and a high frequency of plasma anti-MuSK Ab. This profile appears to be different from that of Caucasian patients. Collaborative studies in the sub-Saharan region on AIMG in general populations are needed.
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Affiliation(s)
- Djingri Labodi LOMPO
- CHU de Tingandogo, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso,*
| | - Nagaonlé Éric SOME
- CHU Yalgado Ouédraogo de Ouagadougou, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Adja Mariam OUEDRAOGO
- Institut de recherche en sciences de la santé Ouagadougou, Département de biologie médicale et santé publique, Ouagadougou, Burkina Faso
| | - Rodrigue P. YONLI
- CHU de Tingandogo, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ousséini DIALLO
- CHU Yalgado Ouédraogo de Ouagadougou, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Christian NAPON
- CHU Yalgado Ouédraogo de Ouagadougou, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Athanase MILLOGO
- CHU Souro Sanou de Bobo-Dioulasso, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Jean KABORE
- CHU Yalgado Ouédraogo de Ouagadougou, Unité de formation et de recherches des sciences de la santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
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Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations. J Clin Med 2021; 10:jcm10112235. [PMID: 34064035 PMCID: PMC8196750 DOI: 10.3390/jcm10112235] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune neurological disorder characterized by defective transmission at the neuromuscular junction. The incidence of the disease is 4.1 to 30 cases per million person-years, and the prevalence rate ranges from 150 to 200 cases per million. MG is considered a classic example of antibody-mediated autoimmune disease. Most patients with MG have autoantibodies against the acetylcholine receptors (AChRs). Less commonly identified autoantibodies include those targeted to muscle-specific kinase (MuSK), low-density lipoprotein receptor-related protein 4 (Lrp4), and agrin. These autoantibodies disrupt cholinergic transmission between nerve terminals and muscle fibers by causing downregulation, destruction, functional blocking of AChRs, or disrupting the clustering of AChRs in the postsynaptic membrane. The core clinical manifestation of MG is fatigable muscle weakness, which may affect ocular, bulbar, respiratory and limb muscles. Clinical manifestations vary according to the type of autoantibody, and whether a thymoma is present.
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Martinez-Meehan D, Abdallah H, Lutfi W, Dhupar R, Christie N, Luketich JD, Sultan I, Okusanya OT. Racial Disparity in Surgical Therapy for Thymic Malignancies. Chest 2020; 159:2050-2059. [PMID: 33301745 DOI: 10.1016/j.chest.2020.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The primary curative treatment for thymic malignancies is surgery. For lung and esophageal cancer, substantive disparities in outcomes by race exist. Many of these disparities are attributed to the decreased use of surgery in non-White patients. Although thymic malignancies are treated by the same specialists as lung and esophageal cancer, it is unknown if there are racial disparities in the treatment of thymic malignancies. RESEARCH QUESTION Do racial disparities exist in the surgical treatment of thymic malignancies? STUDY DESIGN AND METHODS A retrospective cohort analysis was performed using the National Cancer Data Base of patients diagnosed with thymoma and thymic carcinoma between 2004 and 2016. Univariate comparisons of demographics were compared using χ 2 and rank-sum tests. Multivariable analysis was performed to determine if race was an independent variable associated with receiving surgical resection. Preoperative and postoperative care was compared between races. RESULTS Seven thousand four hundred eighty-nine patients met inclusion criteria. Four thousand nine hundred sixty-two (66%) were White, 1,311 (18%) were Black, 487 (7%) were Hispanic, 580 (8%) were Asian or Pacific Islander, and 143 (2%) were other races. Black patients with thymic malignancies were more likely to have a median income < $38,000 and not received surgery. Black and Hispanic patients had the lowest median age (54.3 and 53.6 years, respectively) and were most likely to be uninsured (8.2% and 12.5%, respectively). White patients received surgical therapy 1 week sooner and had a postoperative length of stay 1.5 days shorter than Black patients. Multivariable analysis controlling for age, sex, tumor size, insurance status, comorbidity score, histology, and facility type showed that race remained independently associated with the receipt of surgical resection. White patients had the greatest likelihood of receiving surgery with Black patients being least likely to receive surgery (OR, 0.60). INTERPRETATION A racial disparity exists in surgical therapy for thymic malignancies.
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Affiliation(s)
- Deirdre Martinez-Meehan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Hussein Abdallah
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Waseem Lutfi
- Department of General Surgery, University of Pennsylvania, Philadelphia, PA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Surgical Services Division, Veteran's Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Neil Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Olugbenga T Okusanya
- Department of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, PA.
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Cao M, Koneczny I, Vincent A. Myasthenia Gravis With Antibodies Against Muscle Specific Kinase: An Update on Clinical Features, Pathophysiology and Treatment. Front Mol Neurosci 2020; 13:159. [PMID: 32982689 PMCID: PMC7492727 DOI: 10.3389/fnmol.2020.00159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
Muscle Specific Kinase myasthenia gravis (MuSK-MG) is an autoimmune disease that impairs neuromuscular transmission leading to generalized muscle weakness. Compared to the more common myasthenia gravis with antibodies against the acetylcholine receptor (AChR), MuSK-MG affects mainly the bulbar and respiratory muscles, with more frequent and severe myasthenic crises. Treatments are usually less effective with the need for prolonged, high doses of steroids and other immunosuppressants to control symptoms. Under physiological condition, MuSK regulates a phosphorylation cascade which is fundamental for the development and maintenance of postsynaptic AChR clusters at the neuromuscular junction (NMJ). Agrin, secreted by the motor nerve terminal into the synaptic cleft, binds to low density lipoprotein receptor-related protein 4 (LRP4) which activates MuSK. In MuSK-MG, monovalent MuSK-IgG4 autoantibodies block MuSK-LRP4 interaction preventing MuSK activation and leading to the dispersal of AChR clusters. Lower levels of divalent MuSK IgG1, 2, and 3 antibody subclasses are also present but their contribution to the pathogenesis of the disease remains controversial. This review aims to provide a detailed update on the epidemiological and clinical features of MuSK-MG, focusing on the pathophysiological mechanisms and the latest indications regarding the efficacy and safety of different treatment options.
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Affiliation(s)
- Michelangelo Cao
- Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
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Merrheim J, Villegas J, Van Wassenhove J, Khansa R, Berrih-Aknin S, le Panse R, Dragin N. Estrogen, estrogen-like molecules and autoimmune diseases. Autoimmun Rev 2020; 19:102468. [PMID: 31927086 DOI: 10.1016/j.autrev.2020.102468] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
In western countries, the slope of autoimmune disease (AD) incidence is increasing and affects 5-8% of the population. Mainly prevalent in women, these pathologies are due to thymic tolerance processes breakdown. The female sex hormone, estrogen, is involved in this AD female susceptibility. However, predisposition factors have to act in concert with unknown triggering environmental factors (virus, microbiota, pollution) to initiate AD. Individuals are exposed to various environmental compounds that display endocrine disruption abilities. The cellular effects of some of these molecules may be mediated through the aryl hydrocarbon receptor (AhR). Here, we review the effects of these molecules on the homeostasis of the thymic cells, the immune tolerance intrinsic factors (transcription factors, epigenetic marks) and on the immune tolerance extrinsic factors (microbiota, virus sensibility). This review highlights the contribution of estrogen and endocrine disruptors on the dysregulation of mechanisms sustaining AD development.
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Affiliation(s)
- Judith Merrheim
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - José Villegas
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - Jérôme Van Wassenhove
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - Rémi Khansa
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - Sonia Berrih-Aknin
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - Rozen le Panse
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; AIM, Institute of Myology, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France
| | - Nadine Dragin
- Sorbonne Université, Paris, France; Inserm UMRS 974, Paris, France; Inovarion, Paris, France; Centre de Recherche en Myologie, Sorbonne Université, Inserm UMRS 974, Hôpital La Pitié- Salpêtrière, 105 Bd de l'hôpital, 75013 Paris, France.
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Desai R, Abbas SA, Fong HK, Lodhi MU, Doshi R, Savani S, Gangani K, Sachdeva R, Kumar G. Burden and impact of takotsubo syndrome in myasthenic crisis: A national inpatient perspective on the under-recognized but potentially fatal association. Int J Cardiol 2019; 299:63-66. [PMID: 31611084 DOI: 10.1016/j.ijcard.2019.09.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with myasthenia gravis (MG) remain at a higher risk of developing takotsubo syndrome (TS), particularly during a myasthenic crisis (MC) event. The prevalence of MC-associated TS and its impact on subsequent in-hospital outcomes have not been explored previously. METHODS We queried the National Inpatient Sample (NIS) databases (2007-2014) using weighted data and ICD-9 CM codes to evaluate the prevalence of MC-associated TS, demographics, comorbidities and inpatient outcomes of TS secondary to MC vs. other triggers. RESULTS The nationwide prevalence of MC-associated TS was 0.3% (175/56,472). Of all 156,506 TS encounters, MC was present in 0.11% (n = 175) of cases. The groups were comparable in terms of demographics (median age 68-73 years, Caucasian >70%, females >80%). In comparison to non-MC TS, MC-associated TS demonstrated a higher frequency of coexisting diabetes and a lower frequency of smoking. The MC-TS cohort experienced significantly higher rates of all-cause mortality [8.6% vs. 4.7%, p = 0.014, unadjusted (OR1.91, p = 0.017) and adjusted (OR1.82, p = 0.038)] and complications including respiratory failure, the need of intubation/mechanical ventilation, and arrhythmia. The MC-TS cohort had fewer routine discharges and frequent transfers. The median stay was 6 days longer (10 vs. 4 days) and median hospital charges per admission were nearly $100,000 higher ($133,999 vs. $38,367) with MC-associated TS. CONCLUSIONS This population-based analysis revealed a 15 times greater prevalence of secondary TS following MC as compared to the general inpatient population, a nearly 2 times higher odds of all-cause mortality, and significantly higher resource utilization in MC-associated TS as compared to TS triggered by other etiologies.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.
| | | | - Hee Kong Fong
- Division of Cardiovascular Medicine, UC Davis Health System, Sacramento, CA, USA
| | - Muhammad Uzair Lodhi
- Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, ID, USA
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Sejal Savani
- Public Health, New York University, New York, NY, USA
| | - Kishorbhai Gangani
- Department of Internal Medicine, Texas Health Arlington Memorial Hospital, Arlington, TX, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA; Division of Cardiology, Medical College of Georgia, Augusta, GA, USA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Hehir MK, Silvestri NJ. Generalized Myasthenia Gravis: Classification, Clinical Presentation, Natural History, and Epidemiology. Neurol Clin 2019; 36:253-260. [PMID: 29655448 DOI: 10.1016/j.ncl.2018.01.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Myasthenia gravis (MG) is a rare disease, but the most common disorder of the neuromuscular junction. It is the prototypic autoimmune disease most commonly caused by antibodies to the acetylcholine receptor (AChR) leading to characteristic fatigable weakness of the ocular, bulbar, respiratory, axial, and limb muscles. The majority of patients with MG first present with ocular symptoms. Most patients with MG will experience at least 1 exacerbation of symptoms throughout the course of their illness. This article will cover the epidemiology, clinical presentation, classification, and natural history of MG.
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Affiliation(s)
- Michael K Hehir
- Department of Neurosciences, Larner College of Medicine at the University of Vermont, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
| | - Nicholas J Silvestri
- Department of Neurology, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, 1010 Main Street, Buffalo, New York 14202, USA
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Nagappa M, Mahadevan A, Gangadhar Y, Patil SA, Bokolia S, Bindu PS, Sinha S, Taly AB. Autoantibodies in acquired myasthenia gravis: Clinical phenotype and immunological correlation. Acta Neurol Scand 2019; 139:428-437. [PMID: 30693486 DOI: 10.1111/ane.13071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Data on antibody profile in myasthenia gravis (MG) from India are limited. OBJECTIVES To investigate antibody profile in patients with MG and their clinical correlates. PATIENTS AND METHODS Patients of MG (n = 85, M:F::1.1:1, mean age: 39.29 ± 17.3 years, mean symptom duration: 72.94 ± 91.8 months) were evaluated for clinical features, MG foundation of America (MGFA) score, response to treatment, and outcome at last follow-up. Antibodies to acetylcholine receptor (AChR), muscle-specific kinase (MUSK), titin and ryanodine receptor (RYR) were analysed using ELISA. RESULTS Based on the regional distribution of weakness, the cohort could be categorized as: generalized: 60, ocular: 16 and oculo-bulbar: 9. Sixty patients were followed up for a mean duration of 26.74 ± 13.8 months. Outcome at last follow-up was as follows: remission-22, no remission-33 and dead-5. AChR and MUSK antibodies were detected in 58 and 8 patients, respectively. Frequency of generalized MG, worse MGFA score during the disease course and thymomatous histology significantly correlated with presence of AChR-antibodies, though outcome at last follow-up was comparable between AChR-antibody positive and negative groups. Patients with MUSK antibodies had oculo-bulbar or generalized MG and frequent respiratory crisis, but majority improved or remitted with treatment. Titin antibodies were detected in 31.8% and RYR antibodies in 32.9%. Their presence did not correlate with age at onset of MG, severity or presence of thymoma. CONCLUSION This report highlights the spectrum of antibodies in MG in an Indian cohort. AChR-antibody positivity correlated with clinical severity. Outcome was good in majority of MUSK antibody-positive MG. The role of other antibodies, complementary vs epiphenomenon, remains open.
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Affiliation(s)
- Madhu Nagappa
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
- Neuromuscular Laboratory (NML) Neurobiology Research Centre (NBRC) National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Anita Mahadevan
- Neuromuscular Laboratory (NML) Neurobiology Research Centre (NBRC) National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
- Department of Neuropathology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Yashwanth Gangadhar
- Neuromuscular Laboratory (NML) Neurobiology Research Centre (NBRC) National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
- Department of Neuropathology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Shripad A. Patil
- Department of Neuromicrobiology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Suresh Bokolia
- Department of Neuromicrobiology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Parayil S. Bindu
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
- Neuromuscular Laboratory (NML) Neurobiology Research Centre (NBRC) National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Sanjib Sinha
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Arun B. Taly
- Department of Neurology National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
- Neuromuscular Laboratory (NML) Neurobiology Research Centre (NBRC) National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
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Oh SJ, Jeong D, Lee I, Alsharabati M. Repetitive nerve stimulation test in myasthenic crisis. Muscle Nerve 2019; 59:544-548. [PMID: 30488463 DOI: 10.1002/mus.26390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Herein we report our experience with the repetitive nerve stimulation (RNS) test in myasthenia gravis (MG) crisis. METHODS The various parameters of the RNS tests in 26 patients with MG crisis were analyzed. RESULTS In 18 (69%) patients, MG crisis is the first manifestation of MG. RNS tests were abnormal in 24 (92%) patients by decrement at low-rate stimulation in any of 4 tested muscles. Three patterns of abnormality were found: MG pattern (decrement at low-rate stimulation) in 23 patients; Lambert-Eaton myasthenic syndrome pattern in 1 patient; and cholinergic crisis pattern in 1 patient. DISCUSSION During MG crisis, the RNS test can serve as a rapid and sensitive diagnostic tool for MG in a majority of patients. Muscle Nerve 59:544-544, 2019.
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Affiliation(s)
- Shin J Oh
- Department of Neurology, University of Alabama at Birmingham, UAB Station, Birmingham, Alabama, 35294, USA
| | - Dushin Jeong
- Department of Neurology, University of Alabama at Birmingham, UAB Station, Birmingham, Alabama, 35294, USA.,Department of Neurology College of Medicine Soonchunhayng University, Cheonan, Republic of Korea
| | - Ikjae Lee
- Department of Neurology, University of Alabama at Birmingham, UAB Station, Birmingham, Alabama, 35294, USA
| | - Mohammad Alsharabati
- Department of Neurology, University of Alabama at Birmingham, UAB Station, Birmingham, Alabama, 35294, USA
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14
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Sabre L, Guptill JT, Russo M, Juel VC, Massey JM, Howard JF, Hobson-Webb LD, Punga AR. Circulating microRNA plasma profile in MuSK+ myasthenia gravis. J Neuroimmunol 2018; 325:87-91. [PMID: 30316681 PMCID: PMC6240475 DOI: 10.1016/j.jneuroim.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
Muscle-specific tyrosine kinase antibody positive myasthenia gravis (MuSK+ MG) is an immunological subtype with distinctive pathogenic mechanisms and clinical features. The aim of this study was to analyze the circulating plasma microRNA profile of patients with MuSK+ MG. From the discovery cohort miR-210-3p, miR-324-3p and miR-328-3p were further analyzed in the validation cohort. We found a distinct plasma profile of miR-210-3p and miR-324-3p that were significantly decreased in MuSK+ MG patients compared to healthy controls (4.1 ± 1.4 vs 5.1 ± 1.4, p = .006 and 4.7 ± 1.0 vs 5.4 ± 1.3, p = .02). These findings reveal a distinct plasma miRNA profile in MuSK+ MG.
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Affiliation(s)
- Liis Sabre
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | | | - Melissa Russo
- Department of Neurology, Duke University, Durham, USA
| | - Vern C Juel
- Department of Neurology, Duke University, Durham, USA
| | | | - James F Howard
- Department of Neurology, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | | | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden.
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15
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018. [PMID: 29518096 PMCID: PMC5843234 DOI: 10.1371/journal.pone.0193723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acquired myasthenia gravis (MG) is a prototype autoimmune disease of the neuromuscular junction, caused in most patients by autoantibodies to the muscle nicotinic acetylcholine receptor (AChR). There seem to be ethnic and regional differences in the frequency and clinical features of MG seronegative for the AChR antibody. This study aimed to describe the autoantibody profiles and clinical features of Korean patients with generalized MG seronegative for the AChR antibody. A total of 62 patients with a high index of clinical suspicion of seronegative generalized MG were identified from 18 centers, and we examined their sera for antibodies to clustered AChR, muscle-specific tyrosine kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (LRP4) by cell-based assays (CBA) and to MuSK by radioimmunoprecipitation assay (RIPA). We also included 8 patients with ocular MG, 3 with Lambert-Eaton myasthenic syndrome, 5 with motor neuron disease, and 9 with other diagnoses as comparators for the serological testing. Antibodies were identified in 25/62 (40.3%) patients: 7 had antibodies to clustered AChR, 17 to MuSK, and 2 to LRP4. Three patients were double seropositive: 1 for MuSK and LRP4, and 2 for MuSK and clustered AChR. The patients with MuSK antibodies were mostly female (88.2%) and characterized by predominantly bulbar involvement (70%) and frequent myasthenic crises (58.3%). The patients with antibodies to clustered AChR, including 2 with ocular MG, tended to have a mild phenotype and good prognosis.
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Affiliation(s)
- Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail: (YHH); (PW)
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Thomas Smith
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong-Geon Lim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Republic of Korea
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Byung-Nam Yoon
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University Medical Research Council, Seoul, Republic of Korea
- * E-mail: (YHH); (PW)
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16
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Lee I, Kaminski HJ, Xin H, Cutter G. Gender and quality of life in myasthenia gravis patients from the myasthenia gravis foundation of America registry. Muscle Nerve 2018; 58:90-98. [PMID: 29466829 DOI: 10.1002/mus.26104] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Quality of life (QOL) has been poorly characterized among patients with myasthenia gravis (MG) other than assessments performed within the clinical setting. METHODS Patients age ≥ 18 years who were diagnosed with MG and registered with the MG patient registry between July 1, 2013, and June 30, 2016, were included. Demographic information, disease related history, and QOL were compared between men and women using multivariable analysis. RESULTS A total of 1,315 subjects (827 women) were included. Women were significantly younger, had a younger age at symptom onset, and were more likely to have thymoma and thymectomy. The 15-item Myasthenia Gravis Quality of Life scale (MG-QOL15) was significantly worse in women. MG-QOL15 score was comparable between women who had thymectomy and men with or without thymectomy. DISCUSSION QOL among MG patients is worse in women compared with men, but this disparity is eliminated in women who have undergone thymectomy. Muscle Nerve, 2018.
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Affiliation(s)
- Ikjae Lee
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Henry J Kaminski
- Department of Neurology, The George Washington University, Washington, DC, USA
| | - Haichang Xin
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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17
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Abraham A, Kassardjian CD, Katzberg HD, Bril V, Breiner A. Selective or predominant triceps muscle weakness in African–American patients with myasthenia gravis. Neuromuscul Disord 2017; 27:646-649. [DOI: 10.1016/j.nmd.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/06/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022]
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18
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Effect of ethnic origin and gender on the clinical manifestations of myasthenia gravis among the Jewish population in Israel. J Neuroimmunol 2017; 307:47-52. [DOI: 10.1016/j.jneuroim.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022]
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19
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Boldingh MI, Maniaol A, Brunborg C, Dekker L, Lipka A, Niks EH, Verschuuren J, Tallaksen C. Prevalence and clinical aspects of immigrants with myasthenia gravis in northern Europe. Muscle Nerve 2017; 55:819-827. [PMID: 27641227 DOI: 10.1002/mus.25408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/07/2016] [Accepted: 09/14/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Multiethnic studies can provide etiological clues toward the genetic and environmental influence of a disease. The aim of this study was to determine prevalence and clinical features of myasthenia gravis (MG) in immigrants compared with native patients in 2 population-based cohorts. METHODS This cross-sectional study included 843 MG patients (375 from Norway and 468 from the Netherlands). Ethnic background was defined by questionnaires. RESULTS Among the participating MG patients, 163 of 843 (19.3%) were first or second generation immigrants, mainly from Europe, Asia, and South America. No marked prevalence differences were found between immigrants and native ethnic groups. MG with muscle specific kinase antibodies and MG with thymoma were more frequent in Asian MG immigrants compared with other ethnic groups (8% vs. 0-4%; P < 0.001 and 21% vs. 6-10%; P < 0.001), respectively. CONCLUSIONS Our findings indicate that Asian immigrant MG patients carry genetic factors or environmental/lifestyle factors which contribute to their specific phenotype, even after migration. Muscle Nerve 55: 819-827, 2017.
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Affiliation(s)
- Marion Ingeborg Boldingh
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angelina Maniaol
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway
| | - Cathrine Brunborg
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Luuk Dekker
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Alexander Lipka
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Erik Harmen Niks
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Jan Verschuuren
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Chantal Tallaksen
- Department of Neurology, Oslo University Hospital, pb 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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Valko Y, Weber KP. [Not Available]. PRAXIS 2017; 106:1107-1114. [PMID: 28976252 DOI: 10.1024/1661-8157/a002796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Die Kombination von fluktuierender und belastungsabhängiger Diplopie, Ptose und paretischem Lidschluss – unter Aussparung der Pupillomotorik – ist pathognomonisch für die okuläre Myasthenie. In den ersten zwei Jahren kommt es bei 80 % der Patienten zu einer Generalisierung, mit Entwicklung bulbärer Beschwerden und Schwäche in der Extremitätenmuskulatur. Die Diagnose der okulären Myasthenie gelingt wegen des oft schleichenden Auftretens, der schwierigen Abgrenzung zu anderen neuroophthalmologischen und neurologischen Krankheitsbildern und der niedrigen Sensitivität der apparativen Untersuchungen oft nur mit Verspätung. Eine rasche Diagnose ist wichtig, da effiziente Therapieoptionen eine gute Symptomkontrolle erlauben und weil eine frühe Immunsuppression die Häufigkeit der Konversion zu einer generalisierten Form reduzieren kann.
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Affiliation(s)
- Yulia Valko
- 1 Klinik für Neurologie, Universitätsspital Zürich
| | - Konrad P Weber
- 1 Klinik für Neurologie, Universitätsspital Zürich
- 2 Klinik für Ophthalmologie, Universitätsspital Zürich
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21
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Lee HN, Kang HC, Lee JS, Kim HD, Shin HY, Kim SM, Sunwoo IN, Lee YM. Juvenile Myasthenia Gravis in Korea: Subgroup Analysis According to Sex and Onset Age. J Child Neurol 2016; 31:1561-1568. [PMID: 27581849 DOI: 10.1177/0883073816666206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/16/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022]
Abstract
Juvenile myasthenia gravis presents before 18 years of age with different characteristics according to racial background and pubertal development. The authors aimed to determine the clinical characteristics of children and adolescents of Korean ethnicity with myasthenia gravis, and evaluate the presentation and clinical outcomes according to the sex and onset age of the patients. The authors recruited 88 Korean juvenile myasthenia gravis patients between September 2005 and August 2015. Worse clinical severity from presentation, more aggressive treatment strategies, and worse final treatment outcomes were noted in girls with postpubertal onset than in the other patients. The symptoms were milder (pure ocular presentation in 96.6% [85/88]) and the disease course was more benign (94.3% [83/88]) in this study than in the literature. The homogenous racial background might have contributed to these results. These findings highlight the influence of pubertal development and the need for timely and appropriate active treatment, including thymectomy, to improve prognosis.
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Affiliation(s)
- Ha Neul Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Nam Sunwoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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22
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Huda S, Woodhall MR, Vincent A, Heckmann JM. Characteristics Of acetylcholine-receptor-antibody-negative myasthenia gravis in a South African cohort. Muscle Nerve 2016; 54:1023-1029. [PMID: 27105303 DOI: 10.1002/mus.25154] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/16/2016] [Accepted: 04/20/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION In this study we determined the frequencies of antibodies (Abs) directed against muscle-specific kinase (MuSK) and lipoprotein receptor-related protein 4 (LRP4) in the sera of a South African cohort with acetylcholine receptor (AChR)-antibody-negative generalized MG and determined outcomes to therapies. METHODS Sera negative by commercial AChR radioimmunoassay (RIA) were tested by MuSK RIA (n = 30; 2006-2012) and AChR, MuSK, and LRP4 RIA with or without cell-based assays (CBA) (n = 53; 2012-2015). RESULTS AChR-Abs were detected in 4 of 53 and MuSK-Abs in 20 of 83 (24%) cases. Thirty-six of 53 (68%) were triple seronegative (triple-SNMG) for MuSK, AChR, and LRP4-Abs. When compared with triple-SNMG, individuals with MuSK-MG had a younger onset age (P = 0.008), a greater likelihood of African genetic ancestry (P = 0.008), and 4-fold higher odds of reaching MGFA grade IVB/V (P = 0.018), but were also 9-fold more likely to reach at least minimal manifestations status after ≥12 months of therapy (P = 0.003). CONCLUSIONS Individuals with African genetic ancestry and severe bulbar/respiratory AChR-Ab-negative MG are likely to have MuSK-MG, but most respond favorably to maintenance immunotherapies. Muscle Nerve 54: 1023-1029, 2016.
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Affiliation(s)
- Saif Huda
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mark R Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Jeannine M Heckmann
- Division of Neurology, E8-74, Department of Medicine, University of Cape Town, South Africa
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23
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Karni A, Asmail A, Drory VE, Kolb H, Kesler A. Characterization of patients with ocular myasthenia gravis - A case series. eNeurologicalSci 2016; 4:30-33. [PMID: 29430546 PMCID: PMC5803088 DOI: 10.1016/j.ensci.2016.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/23/2016] [Indexed: 11/12/2022] Open
Abstract
Ocular myasthenia gravis (OMG) is sometimes difficult to diagnose and is probably both under-diagnosed and misdiagnosed. We studied the epidemiological parameters, relevant serology, electromyographic (EMG) findings, and the relationship between OMG and thymoma, thymus hyperplasia and other autoimmune disorders compared to generalized MG (GMG) in a case control study of 133 patients with MG (32 patients with OMG and 101 patients with GMG). The proportion of OMG among all MG patients was relatively high (24.1%). It affected more males than females and its onset was at an older age. Although anti-AChR Ab was detected in fewer OMG patients compared to GMG patients, the rate of positive serology in OMG patients was higher than previously reported. Male OMG patients had a higher positive serology rate than female OMG patients. OMG patients tended to have less supportive EMG evidence of neuromuscular disorder. Female OMG patients had higher rates of thymus hyperplasia and higher rates of other autoimmune disorders than males. Diagnosing MG in patients with solitary ocular manifestation may be difficult due to lower rates of paraclinic supportive tests. Awareness of the characteristics of OMG is important in order to avoid delayed or misdiagnosis of MG and to prevent avoidable iatrogenic complications.
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Affiliation(s)
- Arnon Karni
- Neuroimmunology Clinic, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ali Asmail
- Neuroimmunology Clinic, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivian E. Drory
- Neuromuscular Service of the Department of Neurology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Kolb
- Neuroimmunology Clinic, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Kesler
- Neuro-ophthalmology Unit of the Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gender and Ethnicity Based Differences in Clinical and Laboratory Features of Myasthenia Gravis. Autoimmune Dis 2015; 2015:197893. [PMID: 26175913 PMCID: PMC4484557 DOI: 10.1155/2015/197893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background. Previous reports describe ethnicity based differences in clinical and laboratory features between Caucasians and African Americans with myasthenia gravis. However, it is not known whether these findings apply to other ethnicities. Methods. Retrospective analysis of all patients treated for myasthenia gravis during a three-year period at a community based medical center. Results. A total of 44 patients were included, including 19 of Hispanic, 16 of African American, 6 of Caucasian, and 3 of Asian ethnicities. Female gender was more common among those with Hispanic, Asian, and African American ethnicities compared to Caucasian ethnicity (p = 0.029). Anti-acetylcholine receptor antibody subtypes demonstrated no significant ethnicity based differences in either generalized or ocular myasthenia gravis. A trend was noted towards greater frequency of blocking antibodies among Hispanics (52.6%) compared to African American (37.5%) and Caucasian (33.3%) patients (p = 0.059). Generalized but not ocular myasthenia patients showed greater frequency of anti-muscle specific kinase antibodies in Asians and Hispanics compared to African Americans and Caucasians (p = 0.041). Conclusions. The results of this study support the existence of ethnicity based differences in clinical and laboratory features of myasthenia gravis. Further study of genetic factors influencing clinical features of myasthenia gravis is indicated.
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Skjei KL, Lennon VA, Kuntz NL. Muscle specific kinase autoimmune myasthenia gravis in children: a case series. Neuromuscul Disord 2013; 23:874-82. [PMID: 24012245 DOI: 10.1016/j.nmd.2013.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 11/17/2022]
Abstract
We report clinical, neurophysiological and autoantibody profiles of 9 children presenting with fatigable weakness and MuSK autoantibody seropositivity. Eight were female, 3 were black; median onset age was 8 years. Diplopia or bulbar dysfunction were common presenting symptoms. Half of the patients experienced moderate to severe weakness of bulbar, facial and respiratory muscles (including exacerbations requiring mechanical ventilation). Muscle AChR antibodies were detected transiently in 2 patients but no other autoantibodies were detected. Clinical response to treatment was variable and incomplete. No thymic abnormalities were noted by CT or pathologically (3 underwent thymectomy). Electromyographic (EMG) abnormalities (decrement of compound muscle action potential amplitude during slow repetitive nerve stimulation and variation in individual motor unit potentials) were limited to clinically weak muscles. Single fiber EMG demonstrated abnormalities in an asymptomatic muscle in the single patient studied. As in adults, MuSK autoimmune MG presents more commonly in females, and weakness preferentially affects bulbar, facial and respiratory muscles. Morbidity is significant and responses to standard therapies are variable and incomplete. Neurophysiological confirmation is more challenging in children because testing of weak muscles (cranial nerve-innervated and respiratory) may require moderate sedation and monitoring.
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Affiliation(s)
- Karen L Skjei
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
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Gelber AC, Manno RL, Shah AA, Woods A, Le EN, Boin F, Hummers LK, Wigley FM. Race and association with disease manifestations and mortality in scleroderma: a 20-year experience at the Johns Hopkins Scleroderma Center and review of the literature. Medicine (Baltimore) 2013; 92:191-205. [PMID: 23793108 PMCID: PMC4553970 DOI: 10.1097/md.0b013e31829be125] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Experience suggests that African Americans may express autoimmune disease differently than other racial groups. In the context of systemic sclerosis (scleroderma), we sought to determine whether race was related to a more adverse expression of disease. Between January 1, 1990, and December 31, 2009, a total of 409 African American and 1808 white patients with scleroderma were evaluated at a single university medical center. While the distribution by sex was virtually identical in both groups, at 82% female, African American patients presented to the center at a younger mean age than white patients (47 vs. 53 yr; p < 0.001). Two-thirds of white patients manifested the limited cutaneous subset of disease, whereas the majority of African American patients manifested the diffuse cutaneous subset (p < 0.001). The proportion seropositive for anticentromere antibody was nearly 3-fold greater among white patients, at 34%, compared to African American patients (12%; p < 0.001). Nearly a third of African American (31%) patients had autoantibodies to topoisomerase, compared to 19% of white patients (p = 0.001). Notably, African American patients experienced an increase in prevalence of cardiac (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-2.2), renal (OR, 1.6; 95% CI, 1.2-2.1), digital ischemia (OR, 1.5; 95% CI, 1.4-2.2), muscle (OR, 1.7; 95% CI, 1.3-2.3), and restrictive lung (OR, 6.9; 95% CI, 5.1-9.4) disease. Overall, 700 (32%) patients died (159 African American; 541 white). The cumulative incidence of mortality at 10 years was 43% among African American patients compared to 35% among white patients (log-rank p = 0.0011). Compared to white patients, African American patients experienced an 80% increase in risk of mortality (relative risk [RR], 1.8; 95% CI, 1.4-2.2), after adjustment for age at disease onset and disease duration. Further adjustment by sex, disease subtype, and scleroderma-specific autoantibody status, and for the socioeconomic measures of educational attainment and health insurance status, diminished these risk estimates (RR, 1.3; 95% CI, 1.0-1.6). The heightened risk of mortality persisted in strata defined by age at disease onset, diffuse cutaneous disease, anticentromere seropositivity, decade of care at the center, and among women. These findings support the notion that race is related to a distinct phenotypic profile in scleroderma, and a more unfavorable prognosis among African Americans, warranting heightened diagnostic evaluation and vigilant care of these patients. Further, we provide a chronologic review of the literature regarding race, organ system involvement, and mortality in scleroderma; we furnish synopses of relevant reports, and summarize findings.
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Affiliation(s)
- Allan C Gelber
- From the Departments of Medicine (ACG, RLM, AAS, AW, ENL, FB, LKH, FMW) and Epidemiology (ACG), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Dermatology (ENL), University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
OBJECTIVES To find the characteristic phenotypes of 3 different types of myasthenia gravis (MG). METHODS The clinical and electrophysiological features among 15 cases of muscle-specific kinase antibody positive (MuSK Ab+) MG, 59 cases of double seronegative (DSN) MG, and 161 cases of acetylcholine receptor antibody (AChR Ab)+ MG in the University of Alabama at Birmingham were compared. RESULTS AChR Ab was positive in 69% of cases and MuSK Ab in 6% of cases. MuSK Ab+ MG was more common (14%) in African Americans compared with whites (4%). AChR Ab+ MG is characterized by male predominance, later onset, a fewer cases of ocular MG, and a higher association with thymoma. DSN-MG is characterized by a greater prevalence of ocular MG, milder forms of MG with less number of crisis, and fewer abnormalities in the repetitive nerve stimulation test. MuSK Ab+ MG is characterized by younger age at onset, severe and bulbar forms of MG, predominant faciobulbar neck weakness, and a poor response to edrophonium, anticholinesterase, and intravenous immunoglobulin. Long-term outcome showed no difference among 3 types of MG. CONCLUSIONS AChR Ab+ MG and DSN-MG are similar, with the exception of less severity in the latter. MuSK Ab+ MG has distinct clinical and electrophysiological features.
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Evoli A, Padua L. Diagnosis and therapy of myasthenia gravis with antibodies to muscle-specific kinase. Autoimmun Rev 2013; 12:931-5. [PMID: 23535158 DOI: 10.1016/j.autrev.2013.03.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 01/01/2023]
Abstract
Myasthenia gravis (MG) with antibodies to the muscle-specific receptor tyrosine kinase (MuSK-MG) is a rare disease which covers 5-8% of all MG patients. Symptoms are nearly always generalized, though more focal than in MG with anti-acetylcholine receptor antibodies, with predominant involvement of cranial, bulbar and axial muscles; early respiratory crises are frequent. Focal atrophy, mostly of facial, masseter and tongue muscles, occurs in a proportion of patients. Diagnosis is often challenging on account of atypical presentation with little or no symptom fluctuations, lack of response to acetylcholinesterase inhibitors in a high proportion of patients and negative results of electrodiagnostic studies when performed on limb muscles. Immunosuppression is the mainstay of treatment, since the response to acetylcholinesterase inhibitors is generally unsatisfactory and thymectomy does not appear to improve the course of the disease. Although corticosteroids result in marked improvement, disease flares are frequent during prednisone dosage tapering and most patients remain dependent on treatment. Since treatment with rituximab, in uncontrolled studies, induced sustained benefit in patients with refractory disease, B cell depletion is an attractive option for MuSK-MG patients unresponsive to conventional immunosuppressants.
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Affiliation(s)
- Amelia Evoli
- Institute of Neurology, Catholic University, Largo F. Vito 1, 00168 Roma, Italy.
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Cetin H, Fülöp G, Zach H, Auff E, Zimprich F. Epidemiology of myasthenia gravis in Austria: rising prevalence in an ageing society. Wien Klin Wochenschr 2012; 124:763-8. [PMID: 23129486 DOI: 10.1007/s00508-012-0258-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate recent epidemiological trends of myasthenia gravis (MG) in Austria. METHODS We used the national hospital discharge register, which records the discharge diagnoses of all inpatient stays in Austria to calculate the yearly inpatient prevalence of MG from 1992 to 2009 (main or secondary diagnosis of MG). The population prevalence was indirectly estimated. The temporal and geographical variability of the inpatient prevalence was correlated with the number of practicing neurologists. RESULTS The inpatient prevalence of 2009 was calculated as 8.0 and the population prevalence as 15.69 (95 % CI 13.16-19.42) per 100,000. We observed a 2.2 fold increase in the inpatient prevalence between 1992 and 2009, which was mainly due to a rise in the number of older patients (³ 50 years). Partly this could be accounted for by an ageing of the population as a whole and a rise in the age of hospitalised patients. However, after adjusting for demographic factors an unexplained average yearly rise of 3.7-3.9 % remained. We found a significant spatial and temporal correlation of MG inpatient prevalence rates with the number of practicing neurologists, which increased over the same period. CONCLUSIONS The results from this study support the notion that the prevalence rate of MG in Austria is rising and near the higher end of the wide range discussed in the literature. Our data argue for the importance of specialist neurological care for the diagnosis of this disease.
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Affiliation(s)
- Hakan Cetin
- Department of Clinical Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Guptill JT, Sanders DB, Evoli A. Anti-MuSK antibody myasthenia gravis: clinical findings and response to treatment in two large cohorts. Muscle Nerve 2011; 44:36-40. [PMID: 21674519 DOI: 10.1002/mus.22006] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Myasthenia gravis (MG) patients with autoantibodies to muscle-specific tyrosine kinase (MuSK) represent a distinct subset of those with this disease. Treatment and outcomes data in these patients are limited and conflicting. METHODS We reviewed 110 MuSK-MG patients from two large clinics in Italy and the USA. RESULTS Thirty-nine to 49% of patients with generalized, acetylcholine receptor antibody (AChR-Ab)-negative MG had MuSK-MG. Eighty-five percent were female, with disease onset typically in the fourth decade. Ocular and/or bulbar symptoms were present at onset in 79% of those studied. Eighty-five percent were MGFA class III or greater, and crisis occurred in 28%. Plasma exchange (PLEX) produced improvement in 93%, whereas only 61% improved after intravenous immunoglobulin. Long-term outcomes were comparable to those of patients with AChR-Ab-positive MG. CONCLUSIONS MuSK-MG has a marked female predominance with frequent oculobulbar weakness and crises. Many patients deteriorate rapidly early in the disease, and PLEX is usually the preferred treatment. Long-term outcomes are similar to those of patients with AChR-Ab(+) MG.
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Affiliation(s)
- Jeffrey T Guptill
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Murai H, Yamashita N, Watanabe M, Nomura Y, Motomura M, Yoshikawa H, Nakamura Y, Kawaguchi N, Onodera H, Araga S, Isobe N, Nagai M, Kira JI. Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey. J Neurol Sci 2011; 305:97-102. [DOI: 10.1016/j.jns.2011.03.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 02/23/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
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Abstracts of the 2010 Meeting of the International Neuro-Ophthalmology Society, Lyon, France. Neuroophthalmology 2010. [DOI: 10.3109/01658107.2010.485833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pasnoor M, Wolfe GI, Nations S, Trivedi J, Barohn RJ, Herbelin L, McVey A, Dimachkie M, Kissel J, Walsh R, Amato A, Mozaffar T, Hungs M, Chui L, Goldstein J, Novella S, Burns T, Phillips L, Claussen G, Young A, Bertorini T, Oh S. Clinical findings in MuSK-antibody positive myasthenia gravis: A U.S. experience. Muscle Nerve 2010; 41:370-4. [PMID: 19882635 DOI: 10.1002/mus.21533] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mamatha Pasnoor
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 2012, Kansas City, Kansas 66160, USA.
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Oh SJ. Muscle-specific receptor tyrosine kinase antibody positive myasthenia gravis current status. J Clin Neurol 2009; 5:53-64. [PMID: 19587811 PMCID: PMC2706412 DOI: 10.3988/jcn.2009.5.2.53] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 05/22/2009] [Accepted: 05/22/2009] [Indexed: 12/04/2022] Open
Abstract
Muscle-specific tyrosine-kinase-antibody-positive myasthenia gravis (MuSK-MG) has emerged as a distinct entity since 2001. This disease has been reported worldwide, but with varying rates among patients with generalized acetylcholine-receptor-antibody-negative MG. MuSK-MG was detected in approximately 37% of generalized acetylcholine receptor antibody-negative MG. MuSK-MG patients were predominantly female with more prominent facial and bulbar involvement and more frequent crises. Disease onset tended to be earlier. Patients tended to have a relatively poor edrophonium response but showed prominent decrement in the repetitive nerve stimulation test in the facial muscles. Patients were more likely to display poor tolerance of, or a lack of improvement with, anticholinesterase agents. Somewhat better response was observed with steroids and plasma exchange. Most were managed successfully with aggressive immunomodulatory therapies, although a higher proportion of MuSK-MG patients had a refractory course when compared with other forms of generalized MG. I present here an up-to-date overview on MuSK-MG based on our experience at the University of Alabama at Birmingham and the existing literature.
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Affiliation(s)
- Shin Joong Oh
- Distinguished Professor of Neurology, The University of Alabama at Birmingham, The Veterans Affairs Medical Center, Birmingham, Alabama, USA
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