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Antonioni A, Raho EM, Carlucci D, Sette E, De Gennaro R, Capone JG, Govoni V, Casetta I, Pugliatti M, Granieri E. The Incidence of Myasthenia Gravis in the Province of Ferrara, Italy, in the Period of 2008-2022: An Update on a 40-Year Observation and the Influence of the COVID-19 Pandemic. J Clin Med 2023; 13:236. [PMID: 38202243 PMCID: PMC10780173 DOI: 10.3390/jcm13010236] [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: 12/06/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Myasthenia gravis (MG) is the most common neuromuscular junction disorder. We evaluated the MG incidence rate in the province of Ferrara, Northern Italy, over two time frames (2008-2018 and 2019-2022, i.e., the COVID-19 pandemic) and considered early-onset (EOMG), late-onset (LOMG), and thymoma- and non-thymoma-associated MG. Moreover, in the second period, we assessed its possible relationship with SARS-CoV-2 infection or COVID-19 vaccination. We used a complete enumeration approach to estimate the MG incidence and its temporal trend. For the period of 2008-18, 106 new cases were identified (mean incidence rate 2.7/100,000 people). The highest rates were observed for the over-70 age group and in rural areas, with 17% of thymoma-associated MG. During the COVID-19 period, 29 new cases were identified (average incidence rate 2.1/100,000 people), showing a marked (though not statistically significant) decrease in the mean annual incidence compared to the previous period. Again, the highest rate was observed for the over-70 age group. The first period was in line with our previous observations for the period between 1985 and 2007, highlighting a rising incidence of LOMG and a marked decrease in EOMG. During the COVID-19 period, incidence rates were lower in the first years whereas, when the pandemic ended, the previous trend was confirmed.
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Affiliation(s)
- Annibale Antonioni
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Emanuela Maria Raho
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Domenico Carlucci
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Elisabetta Sette
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Riccardo De Gennaro
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Jay Guido Capone
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Vittorio Govoni
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Ilaria Casetta
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Maura Pugliatti
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Enrico Granieri
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
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Heckmann JM, Europa TA, Soni AJ, Nel M. The Epidemiology and Phenotypes of Ocular Manifestations in Childhood and Juvenile Myasthenia Gravis: A Review. Front Neurol 2022; 13:834212. [PMID: 35280301 PMCID: PMC8904732 DOI: 10.3389/fneur.2022.834212] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Abstract
Myasthenia gravis (MG) appears to have a similar incidence among adult populations worldwide. However, epidemiological and phenotypic differences have been noted among children and juveniles with MG. We reviewed the literature on childhood- and juvenile-onset MG among different populations, with the focus on ocular involvement, antibody profiles, the genetic susceptibility to juvenile MG phenotypes, the use of immune treatments, and the reported responses of extraocular muscles to therapies. Although epidemiological studies used different methodologies, reports from Asia, compared to Europe, showed more than two-fold higher proportions of prepubertal onset (before 12 years) vs. postpubertal-onset juveniles with MG. Compared to European children, ocular MG was 4-fold more frequent among Asian children, and 2–3-fold more frequent among children with African ancestry both in prepubertal and postpubertal ages at onset. These results suggest genetic influences. In Asia, HLA-B*46 and DRB1*09 appeared overrepresented in children with ocular MG. In Europe, children with MG had a significantly higher rate of transforming from ocular to generalized disease and with an overrepresentation of HLADRB1*04. Although treatment regimens vary widely and the responses to immune therapies of the ocular muscles involved in MG were generally poorly described, there were indications that earlier use of steroid therapy may have better outcomes. Reports of treatment-resistant ophthalmoplegia may be more frequent in African and Asian juvenile MG cohorts compared to Europeans. Genetic and muscle gene expression studies point to dysregulated muscle atrophy signaling and mitochondrial metabolism pathways as pathogenetic mechanisms underpinning treatment-resistant ophthalmoplegia in susceptible individuals. In conclusion, phenotypic differences in juveniles with ocular manifestations of MG were evident in different populations suggesting pathogenetic influences. Treatment responses in MG-associated ocular disease should attract more careful descriptive reports. In MG, extraocular muscles may be vulnerable to critical periods of poor force generation and certain individuals may be particularly susceptible to developing treatment-resistant ophthalmoplegia. The development of prognostic biomarkers to identify these susceptible individuals is an unmet need.
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Affiliation(s)
- Jeannine M Heckmann
- Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Neurology Research Group, University of Cape Town (UCT) Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Tarin A Europa
- Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Neurology Research Group, University of Cape Town (UCT) Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Aayesha J Soni
- Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Melissa Nel
- Neurology Research Group, University of Cape Town (UCT) Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Heckmann JM, Nel M. A unique subphenotype of myasthenia gravis. Ann N Y Acad Sci 2017; 1412:14-20. [DOI: 10.1111/nyas.13471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Jeannine M. Heckmann
- Neurology Division, Department of Medicine; University of Cape Town, Groote Schuur Hospital; Cape Town South Africa
- Neurology Research Group, Department of Medicine; University of Cape Town; Cape Town South Africa
| | - Melissa Nel
- Neurology Research Group, Department of Medicine; University of Cape Town; Cape Town South Africa
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