1
|
Birnbaum S, Sharshar T, Ropers J, Portero P, Hogrel JY. Neuromuscular fatigue in autoimmune myasthenia gravis: A cross-sectional study. Neurophysiol Clin 2023; 53:102844. [PMID: 36827843 DOI: 10.1016/j.neucli.2023.102844] [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: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES To investigate the presence of increased neuromuscular fatigue (NMF) in individuals with myasthenia gravis (IwMG), compared to healthy controls. A secondary aim was to assess associations between NMF, strength and perceived health-related quality of life (HRQoL) and symptom severity in IwMG. METHODS In this cross-sectional study, we assessed NMF using classical myoelectrical indicators (root mean square: RMS, mean power frequency: MPF) obtained from surface electromyography (sEMG) during a sustained submaximal isometric contraction of the right Biceps Brachii and the right Vastus Lateralis and by evaluating the post-effort decline in peak torque following a fatiguing task consisting of a 40-second sustained isometric contraction. Relationships with MG-specific clinical scores (Myasthenia Muscle Score for symptom severity, MGQOL-15-F for HRQoL) were investigated. RESULTS Forty-one females with MG were compared to 18 control females of similar age. IwMG demonstrated reduced strength in both muscle groups, compared to control subjects. In both populations and both limbs, NMF was demonstrated by an increase in RMS and a decrease in MPF. However, IwMG did not demonstrate greater NMF based on these myoelectrical indicators nor based on post-effort peak torque decline. DISCUSSION Despite a decrease in baseline strength, IwMG did not display greater NMF in this specific experimental paradigm. This cohort consisted of individuals with mild-to-moderately severe MG which was well-controlled and stable. Further studies are warranted to identify simple and reliable methods to measure NMF in MG and to understand the relationship between NMF and perceived fatigue in activities of daily living for IwMG.
Collapse
Affiliation(s)
- Simone Birnbaum
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière University Hospital, 75651 Paris Cedex 13, France.
| | - Tarek Sharshar
- Anaesthesiology and ICU department, GHU-Psychiatry & Neurosciences, Sainte-Anne Hospital, Université Paris Cité, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Paris, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Pierre Portero
- Bioingénierie, Tissus et Neuroplasticité, EA 7377 Université Paris-Est Créteil, Faculté de Médecine, 8 rue Jean Sarrail, 94010 Créteil, France
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière University Hospital, 75651 Paris Cedex 13, France
| |
Collapse
|
2
|
Muppidi S, Silvestri NJ, Tan R, Riggs K, Leighton T, Phillips GA. Utilization of MG-ADL in myasthenia gravis clinical research and care. Muscle Nerve 2022; 65:630-639. [PMID: 34989427 PMCID: PMC9302997 DOI: 10.1002/mus.27476] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
The Myasthenia Gravis Activities of Living (MG‐ADL) scale is an 8‐item patient‐reported scale that measures myasthenia gravis (MG) symptoms and functional status. The objective of the current review is to summarize the psychometric properties of the MG‐ADL and published evidence of MG‐ADL use. A targeted literature review for published studies of the MG‐ADL was conducted using a database and gray literature search. A total of 48 publications and 35 clinical trials were included. Studies indicated that the MG‐ADL is a reliable and valid measure that has been used as an outcome in clinical trials and observational studies to measure MG symptoms and response to treatment. While most often used as a secondary endpoint in clinical trials, its use as a primary endpoint has increased in recent years. The most common MG‐ADL endpoint is change in MG‐ADL score from baseline, although there has been an increase in the analysis of a responder threshold using the MG‐ADL. A new concept of minimal symptom expression (MSE) has emerged more recently. Duration of treatment effect is another important construct that is being increasingly evaluated using the MG‐ADL. The use of the MG‐ADL as a primary endpoint in clinical trials and in responder threshold analyses to indicate treatment improvement has increased in recent years. MSE using the MG‐ADL shows promise in helping to determine success of treatment and may be the aspirational goal of MG treatment for the future once validated, particularly given the evolving treatment landscape in MG.
Collapse
Affiliation(s)
- Srikanth Muppidi
- Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas J Silvestri
- Department of Neurology, State University of New York, Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | | | | | | | | |
Collapse
|
3
|
Contreras JP, Salinas R, Vidal C, Hoffmeister L, Wolfe GI, Cea G. Validation of Spanish version of 15-item myasthenia gravis quality-of-life questionnaire. Acta Neurol Scand 2021; 144:546-552. [PMID: 34131909 DOI: 10.1111/ane.13486] [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: 02/06/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to achieve the translation and cross-cultural adaptation of the MG-QOL15R questionnaire into Spanish and the analysis of its psychometric properties. MATERIALS AND METHODS We recruited patients with MG, ≥18 years old, whose mother tongue was Spanish. After the translation and cross-cultural adaptation of the MG-QOL15-R, the following tests were performed: internal consistency using the Cronbach-α coefficient and corrected item-total correlations; reproducibility with a test-retest analysis using intraclass correlation coefficients; and concurrent validity using Spearman's correlation coefficient of the Spanish language MG-QOL15R-S, Myasthenia Gravis Activity of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores. As an approximation to construct validity, the nonparametric Mann-Whitney U test was performed between MG-QOL15R-S scores according to the Myasthenia Gravis Foundation of America classification. RESULTS A total of 83 MG patients were enrolled, mean age 48.19 ± 17.25 years; 58 (69.9%) were women. The mean MG-QOL15R-S score was 11.3 ± 7.1. Cronbach-α coefficient was 0.92. Item-total correlation ranged between 0.43 and 0.75. Intraclass correlation coefficient was 0.80. The Spearman correlation coefficient was 0.637 (p-value < .001) for MG-ADL and 0.487 (p-value < .001) for QMG. Mann-Whitney U tests of the mean MG-QOL15R-S scores were significantly different according to the clinical severity (p-value < .001). CONCLUSIONS The Spanish version of the MG-QOL15R is a valid and reliable instrument and potentially useful for measuring health-related quality of life in Spanish-speaking MG patients.
Collapse
Affiliation(s)
- Juan Pablo Contreras
- Departamento de Ciencias Neurologicas Oriente Facultad de Medicina, Universidad de Chile Santiago Chile
| | - Rodrigo Salinas
- Departamento de Ciencias Neurologicas Oriente Facultad de Medicina, Universidad de Chile Santiago Chile
- Servicio de Neurologia, Hospital Salvador Servicio de Salud Metropolitano Oriente Santiago Chile
| | - Carolina Vidal
- Escuela de Salud Pública Universidad Mayor Santiago Chile
| | | | - Gil I. Wolfe
- Department of Neurology University at Buffalo Jacobs School of Medicine and Biomedical Sciences State University of New York Buffalo NY USA
| | - Gabriel Cea
- Departamento de Ciencias Neurologicas Oriente Facultad de Medicina, Universidad de Chile Santiago Chile
- Servicio de Neurologia, Hospital Salvador Servicio de Salud Metropolitano Oriente Santiago Chile
| |
Collapse
|
4
|
Birnbaum S, Porcher R, Sharshar T. Adequate Initial Dosage and Tapering Methods of Steroids to Reduce the Total Corticosteroid Dose in Myasthenia Gravis-Reply. JAMA Neurol 2021; 78:1153-1154. [PMID: 34338728 DOI: 10.1001/jamaneurol.2021.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Raphaël Porcher
- Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tarek Sharshar
- General Intensive Care Unit, GHU-Psychiatrie and Neurosciences, Site Sainte-Anne, Paris, France
| |
Collapse
|
5
|
Birnbaum S, Bachasson D, Sharshar T, Porcher R, Hogrel JY, Portero P. Free-Living Physical Activity and Sedentary Behaviour in Autoimmune Myasthenia Gravis: A Cross-Sectional Study. J Neuromuscul Dis 2021; 8:689-697. [PMID: 33843693 DOI: 10.3233/jnd-210637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Muscle weakness and fatigability, the prominent symptoms of autoimmune myasthenia gravis (MG), negatively impact daily function and quality of life (QoL). It is currently unclear as to what extent symptoms limit activity and whether physical activity (PA) behaviours are associated with reduced QoL. OBJECTIVES This study aimed to describe habitual PA patterns and explore relationships between PA metrics, clinical MG characteristics, and health-related QoL (HRQoL). METHODS PA data from a tri-axial trunk accelerometer worn for seven days, was collected from females with generalized, stable MG and compared to control subjects. MG-specific evaluations, the six-minute walk test and knee extension strength were assessed in individuals with MG (IwMG). Mann-Whitney tests were used to study between-group differences. Spearman rank correlation coefficient was performed to explore relationships between variables. RESULTS Thirty-three IwMG (mean (SD) age 45 (11) years) and 66 control subjects were included. IwMG perform less vigorous-intensity PA than control subjects (p = 0.001), spend more time sedentary (p = 0.02) and engage in less and shorter durations of moderate-vigorous-intensity PA (MVPA). For IwMG, habitual PA correlated positively with 6 min walking distance (rho = 0.387, p = 0.029) and negatively with body mass index (rho = -0.407, p = 0.019). We did not find any association between PA or sedentary behaviour and; HRQoL, symptom severity nor lower limb strength. CONCLUSIONS Individuals with stable MG perform less PA, at lower intensities, and are more inactive than control individuals. Further research is warranted to understand factors influencing PA patterns in MG and whether interventions could be successful in increasing PA quantity and intensity in IwMG.
Collapse
Affiliation(s)
- Simone Birnbaum
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France.,Bioingénierie, Tissus et Neuroplasticité, EA Université Paris-Est Créteil, Créteil, France.,Unité de Recherche Clinique Paris Île-de-France Ouest (URC PIFO), Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Damien Bachasson
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Tarek Sharshar
- Intensive Care Unit, Raymond Poincaré Hospital, AP-HP, Garches, France.,Paris-Descartes University, France.,Experimental Neuropathology, Institut Pasteur, Paris, France
| | - Raphaël Porcher
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Pierre Portero
- Bioingénierie, Tissus et Neuroplasticité, EA Université Paris-Est Créteil, Créteil, France
| |
Collapse
|
6
|
Birnbaum S, Porcher R, Portero P, Clair B, Demeret S, Eymard B, Gargiulo M, Louët E, Berrih-Aknin S, Le Panse R, Aegerter P, Hogrel JY, Sharshar T. Home-based exercise in autoimmune myasthenia gravis: A randomized controlled trial. Neuromuscul Disord 2021; 31:726-735. [PMID: 34304969 DOI: 10.1016/j.nmd.2021.05.002] [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: 11/16/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
The tolerance of exercise and its effects on quality of life in myasthenia gravis are not currently backed up by strong evidence. The aim of this study was to determine whether exercise as an adjunct therapy is well tolerated and can improve health-related quality of life (HRQoL) in stabilized, generalized autoimmune myasthenia gravis (gMG). We conducted a parallel-group, multi-center prospective RCT using computer-generated block randomization. Adults with stabilized, gMG, and no contra-indication to exercise, were eligible. Participants received usual care alone or usual care and exercise. The exercise intervention consisted of 3-weekly 40 min sessions of an unsupervised, moderate-intensity home rowing program over 3 months. The primary endpoint was the change in HRQoL from randomization to post-intervention. Assessor-blinded secondary endpoints were exercise tolerance and effects on clinical, psychological and immunological status. Of 138 patients screened between October 2014 and July 2017, 45 were randomly assigned to exercise (n = 23) or usual care (n = 20). Although exercise was well tolerated, the intention-to-treat analysis revealed no evidence of improved HRQoL compared to usual care (MGQOL-15-F; mean adjusted between-groups difference of -0.8 points, 95%CI -5.4 to 3.7). Two patients hospitalized for MG exacerbation were from the usual care group.
Collapse
Affiliation(s)
| | - R Porcher
- Hotel-Dieu Hospital Clinical Epidemiology Centre, Paris, France
| | - P Portero
- Université Paris-Est, Creteil, France
| | - B Clair
- APHP, Assistance Publique - Hopitaux de Paris, France
| | - S Demeret
- APHP, Assistance Publique - Hopitaux de Paris, France
| | - B Eymard
- Paris Descartes University Institute of Psychology, Paris, France
| | | | - E Louët
- Institute of Myology, Paris, France
| | | | - R Le Panse
- Paris Descartes University Institute of Psychology, Paris, France
| | - P Aegerter
- APHP, Assistance Publique - Hopitaux de Paris, France
| | | | - T Sharshar
- GHU-Psychiatrie & Neurosciences site Sainte-Anne 75014 Paris, France.
| | | |
Collapse
|
7
|
Barnett C, Herbelin L, Dimachkie MM, Barohn RJ. Measuring Clinical Treatment Response in Myasthenia Gravis. Neurol Clin 2019; 36:339-353. [PMID: 29655453 DOI: 10.1016/j.ncl.2018.01.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this article we provide an overview of health-related outcome measurement-to better understand what different outcomes used in myasthenia actually measure-and to provide some guidance when choosing measures based on the clinical context and question. In myasthenia, the most commonly used outcome measures are aimed at assessing the signs and symptoms. In this review, we provide a summary of the most commonly used outcome measures. We discuss instruments that gauge disease overall health impact, such as on disability and quality of life. Finally, we discuss other relevant outcomes such as steroid-sparing effects and the role of surrogate markers.
Collapse
Affiliation(s)
- Carolina Barnett
- Neurology (Medicine), University of Toronto, University Health Network, Toronto, Ontario, Canada.
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| |
Collapse
|
8
|
Barnett C, Bril V, Bayoumi AM. EQ-5D-5L and SF-6D health utility index scores in patients with myasthenia gravis. Eur J Neurol 2018; 26:452-459. [PMID: 30315714 DOI: 10.1111/ene.13836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/08/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Health utilities are a preference-based method of valuing health states that are used in healthcare research, such as economic evaluations. There are limited health utility valuation data for patients with myasthenia gravis (MG). The aim of the study was to describe health utilities for patients with MG and different health states, using the EQ-5D-5L and SF-6D utility instruments, and to explore clinical and demographic determinants of utilities in this population. METHODS Patients completed the EQ-5D-5L and SF-6D. In addition, patients were assessed with the Myasthenia Gravis Foundation of America classification, Myasthenia Gravis Impairment Index and MG-QOL15 as disease-specific measures, and the Neuro-QoL Fatigue scale. We calculated mean utilities for each Myasthenia Gravis Foundation of America severity class. We built regression models for the EQ-5D-5L and SF-6D to determine the clinical and demographic factors that determine patients' valuation of their health state. RESULTS Among 254 patients, mean EQ-5D-5L health utilities were as follows: Remission, 0.94 ± 0.03; Minimal Manifestations, 0.92 ± 0.04; Class I, 0.89 ± 0.06; Class II, 0.78 ± 0.16; Class III, 0.58 ± 0.24 and Class IV, 0.61 ± 0.22. Mean SF-6D health utilities were as follows: Remission, 0.83 ± 0.07; Minimal Manifestations, 0.86 ± 0.14; Class I, 0.82 ± 0.14; Class II, 0.67 ± 0.12; Class III, 0.56 ± 0.11 and Class IV, 0.50 ± 0.10. The limb/axial scores were more highly correlated to health utilities than ocular or bulbar scores. CONCLUSIONS We present estimates of health utilities for patients with MG that can be used in cost-utility and decision analyses. Limb/axial symptoms had a higher impact on health utilities than ocular or bulbar symptoms, which might reflect the impact of mobility on health valuation.
Collapse
Affiliation(s)
- C Barnett
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - V Bril
- Division of Neurology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON
| | - A M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.,Division of General Internal Medicine, Department of Medicine, St, Michael's Hospital, Toronto, ON.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
9
|
Miao X, Lian Z, Liu J, Chen H, Shi Z, Li M, Zhou H, Hu X, Yang R. Translation, cross-cultural adaptation, and validation of the chinese version of the 15-item myasthenia gravis quality of life questionnaire. Muscle Nerve 2018; 59:95-99. [PMID: 30055010 DOI: 10.1002/mus.26313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We sought to translate, cross-culturally adapt, and evaluate the internal consistency and validity of the Chinese version of the 15-Item Myasthenia Gravis Quality of Life (MG-QOL15). METHODS Translation and cross-cultural adaptation of the MG-QOL15 were performed. We used Cronbach's α to test internal consistency, one-way analysis of variance to test construct validity, and Pearson or Spearman correlations to test discriminant and concurrent validity. RESULTS We enrolled 168 outpatients. Internal consistency was excellent (Cronbach's α = 0.928). The MG-QOL15 discriminated MG severity as stratified by the MG Composite (MGC; P < 0.001) and Osserman class (P = 0.01). Concurrent validity was low to moderate with the subscales of the 36-item Short Form (-0.31 to ∼-0.59), MGC (r = 0.46), and Myasthenia Gravis Activities of Daily Living profile (r = 0.54). DISCUSSION The Chinese MG-QOL15 showed comparable construct, discriminant and concurrent validity, and internal consistency with to the original version. Muscle Nerve 59:95-99, 2019.
Collapse
Affiliation(s)
- Xiaohui Miao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhiyun Lian
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ju Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Mier Li
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuying Hu
- Department of Nursing, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Rong Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
10
|
Birnbaum S, Hogrel JY, Porcher R, Portero P, Clair B, Eymard B, Demeret S, Bassez G, Gargiulo M, Louët E, Berrih-Aknin S, Jobic A, Aegerter P, Thoumie P, Sharshar T. The benefits and tolerance of exercise in myasthenia gravis (MGEX): study protocol for a randomised controlled trial. Trials 2018; 19:49. [PMID: 29347991 PMCID: PMC5774148 DOI: 10.1186/s13063-017-2433-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research exploring the effects of physical exercise in auto-immune myasthenia gravis (MG) is scarce. The few existing studies present methodological shortcomings limiting the conclusions and generalisability of results. It is hypothesised that exercise could have positive physical, psychological as well as immunomodulatory effects and may be a beneficial addition to current pharmacological management of this chronic disease. The aim of this study is to evaluate the benefits on perceived quality of life (QOL) and physical fitness of a home-based physical exercise program compared to usual care, for patients with stabilised, generalised auto-immune MG. METHODS MGEX is a multi-centre, interventional, randomised, single-blind, two-arm parallel group, controlled trial. Forty-two patients will be recruited, aged 18-70 years. Following a three-month observation period, patients will be randomised into a control or experimental group. The experimental group will undertake a 40-min home-based physical exercise program using a rowing machine, three times a week for three months, as an add-on to usual care. The control group will receive usual care with no additional treatment. All patients will be followed up for a further three months. The primary outcome is the mean change in MGQOL-15-F score between three and six months (i.e. pre-intervention and immediately post-intervention periods). The MGQOL-15-F is an MG-specific patient-reported QOL questionnaire. Secondary outcomes include the evaluation of deficits and functional limitations via MG-specific clinical scores (Myasthenia Muscle Score and MG-Activities of Daily Living scale), muscle force and fatigue, respiratory function, free-living physical activity as well as evaluations of anxiety, depression, self-esteem and overall QOL with the WHO-QOL BREF questionnaire. Exercise workload will be assessed as well as multiple safety measures (ECG, biological markers, medication type and dosage and any disease exacerbation or crisis). DISCUSSION This is the largest randomised controlled trial to date evaluating the benefits and tolerance of physical exercise in this patient population. The comprehensive evaluations using standardised outcome measures should provide much awaited information for both patients and the scientific community. This study is ongoing. TRIAL REGISTRATION ClinicalTrials.gov, NCT02066519 . Registered on 13 January 2014.
Collapse
Affiliation(s)
- Simone Birnbaum
- Institute of Myology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Bioingénierie, Tissus et Neuroplasticité (BIOTN) EA 7377, University Paris-Est, UPEC, Créteil, France
| | - Jean-Yves Hogrel
- Institute of Myology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Hôtel-Dieu, AP-HP, Paris, France
| | - Pierre Portero
- Bioingénierie, Tissus et Neuroplasticité (BIOTN) EA 7377, University Paris-Est, UPEC, Créteil, France
- Rothschild Hospital, AP-HP, Paris, France
| | - Bernard Clair
- Intensive Care Unit, Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Bruno Eymard
- Institute of Myology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Sophie Demeret
- Neurological Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Bassez
- Institute of Myology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
| | - Marcela Gargiulo
- Institute of Myology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France
- Laboratory of Clinical Psychology, Psychopathology, and Psychoanalysis (EA 4056) Paris Descartes University – Sorbonne Paris Cité, Paris, France
| | - Estelle Louët
- Laboratory of Clinical Psychology, Psychopathology, and Psychoanalysis (EA 4056) Paris Descartes University – Sorbonne Paris Cité, Paris, France
| | - Sonia Berrih-Aknin
- UMRS 974 UPMC, INSERM, FRE 3617 CNRS, AIM, Centre of Research in Myology, Paris, France
| | - Asmaa Jobic
- Unité de Recherche Clinique Paris ÎIle- de- France Ouest (URCPO), Ambroise Paré Hospital, Boulogne Billancourt, France
- Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Philippe Aegerter
- Unité de Recherche Clinique Paris ÎIle- de- France Ouest (URCPO), Ambroise Paré Hospital, Boulogne Billancourt, France
- Raymond Poincaré Hospital, AP-HP, Garches, France
- UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
- INSERM, U1168 VIMA, Villejuif, France
| | | | - Tarek Sharshar
- Intensive Care Unit, Raymond Poincaré Hospital, AP-HP, Garches, France
- University of Versailles, Saint-Quentin-en-Yvelines, France
- Department of Histopathology and Animal Models, Institut Pasteur, Paris, France
| |
Collapse
|
11
|
Alanazy MH, Abuzinadah AR, Muayqil T. Translation and validation of the arabic version of the revised 15‐item myasthenia gravis quality‐of‐life questionnaire. Muscle Nerve 2017; 57:581-585. [DOI: 10.1002/mus.25948] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/12/2017] [Accepted: 08/27/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Mohammed H. Alanazy
- Division of NeurologyDepartment of Internal Medicine, King Saud UniversityPO Box 7805, Riyadh11472 Saudi Arabia
| | | | - Taim Muayqil
- Division of NeurologyDepartment of Internal Medicine, King Saud UniversityPO Box 7805, Riyadh11472 Saudi Arabia
| |
Collapse
|
12
|
Strijbos E, Gärtner FR, Verschuuren JJ. Translation and validation of the 15-item Myasthenia Gravis Quality of life scale in Dutch. Muscle Nerve 2017; 57:206-211. [DOI: 10.1002/mus.25641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ellen Strijbos
- Department of Neurology; Leiden University Medical Center; Albinusdreef 2, 2333 ZA, Leiden The Netherlands
| | - Fania R. Gärtner
- Department of Medical Decision Making; Leiden University Medical Center; Leiden The Netherlands
| | - Jan J. Verschuuren
- Department of Neurology; Leiden University Medical Center; Albinusdreef 2, 2333 ZA, Leiden The Netherlands
| |
Collapse
|
13
|
Raggi A, Leonardi M, Ayadi R, Antozzi C, Maggi L, Baggi F, Mantegazza R. Validation of the italian version of the 15‐item Myasthenia Gravis Quality‐of‐Life questionnaire. Muscle Nerve 2017; 56:716-720. [DOI: 10.1002/mus.25545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS FoundationVia Celoria 11, 20133Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS FoundationVia Celoria 11, 20133Milan Italy
| | - Roberta Ayadi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS FoundationVia Celoria 11, 20133Milan Italy
| | - Carlo Antozzi
- Department of Neuroimmunology and Neuromuscular DisordersNeurological Institute C. Besta IRCCS FoundationMilan Italy
| | - Lorenzo Maggi
- Department of Neuroimmunology and Neuromuscular DisordersNeurological Institute C. Besta IRCCS FoundationMilan Italy
| | - Fulvio Baggi
- Department of Neuroimmunology and Neuromuscular DisordersNeurological Institute C. Besta IRCCS FoundationMilan Italy
| | - Renato Mantegazza
- Department of Neuroimmunology and Neuromuscular DisordersNeurological Institute C. Besta IRCCS FoundationMilan Italy
| |
Collapse
|