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Crescioli G, Finocchietti M, Paoletti O, Brunori P, Sciancalepore F, Tuccori M, Addis A, Vannacci A, Lombardi N, Kirchmayer U. Potentially inappropriate drug use in myasthenia gravis: a real-world population-based cohort study in Italy. Front Neurol 2023; 14:1293626. [PMID: 38178892 PMCID: PMC10764541 DOI: 10.3389/fneur.2023.1293626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction To evaluate the use of pyridostigmine in presence of contraindications, and the use of concomitant potentially contraindicated drugs in a cohort of patients affected by Myasthenia Gravis (MG) in the Italian Regions of Lazio, Tuscany, and Umbria. Methods This is a retrospective cohort study. A multivariate logistic regression model was used to evaluate the determinants of pyridostigmine and of potentially contraindicated drugs use in MG patients. Results Among 591 incident pyridostigmine users affected by MG, 91 (15.4%) had at least one of the contraindications considered at the first prescription of pyridostigmine. Patients prescribed with pyridostigmine in presence of contraindications were more frequently affected by diabetes, obesity, and renal diseases. Age 75+ years (odds ratio, OR 4.94, 95% confidence interval, CI 1.60-15.22 for Latium; OR 3.78, 95%CI: 1.26-11.34 for Tuscany; OR 5.83, 95%CI 1.19-28.52 for Umbria), the presence of at least one specific comorbidity (OR 3.93; 95%CI 1.68-9.17 for Latium), and polytherapy (6+ drugs, OR 4.90, 95%CI: 1.35-17.85 for Tuscany) were found to be significantly associated with pyridostigmine use in presence of contraindications. Among patients affected by MG, 1,483 (62.6%) were treated with potentially contraindicated drugs in the first year of follow-up (67.06.9% in Latium; 59% in Tuscany; 57.6% in Umbria). Patients aged 75+ years, those with at least one specific complication or comorbidity, and those exposed to polytherapy were more likely to be treated with a potential contraindicated drug. Conclusion Among incident users of pyridostigmine, more than 15% of patients have at least one of the contraindications considered, and among patients diagnosed with MG, in the first year of follow-up >60% of subjects were treated with potentially contraindicated drugs.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | | | - Olga Paoletti
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Paola Brunori
- Unit of Neurophysiopathology, Perugia Hospital, Perugia, Italy
| | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Marco Tuccori
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
- Department of Clinical and Experimental Medicine, Unit of Pharmacology and Pharmacovigilance, University of Pisa, Pisa, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Salem S, Saad I, Alamri R. Thymoma associated myasthenia gravis with atypical presentation of lipomatous tongue atrophy: a case report. Pan Afr Med J 2019; 32:38. [PMID: 31143343 PMCID: PMC6522161 DOI: 10.11604/pamj.2019.32.38.17768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/15/2019] [Indexed: 11/20/2022] Open
Abstract
A 28-year-old female patient came to the outpatient dental clinic for multiple teeth extractions and full mouth rehabilitation suffer from myasthenia gravis (MG) primary presentation as tongue atrophy and facial muscles weakness and the symptoms became worries, the patient unable to speak as well and change her voice and complaining of dysphagia and dysarthria. Oral symptoms, treatment schedule and protocol, the selection, prescription and impacts of medications, and prevention of myasthenic crisis are all important; aspects should be considered by dentists and oral health care providers. Weakness of facial and oropharyngeal muscle is considered very popular at disease onset and therefore oral health providers are often the first medical professionals to observe these patients. Myasthenic patients seek particular approach and consultation in order to ensure ideal and proper dental management.
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Affiliation(s)
- Suzan Salem
- Qassim University, College of Dentistry, Department of Oral Surgery, Maxillofacial and Diagnostic Science, Kingdom of Saudi Arabia
| | - Islam Saad
- Qassim University, College of Dentistry, Periodontology and Oral Medicine, Kingdom of Saudi Arabia
| | - Rana Alamri
- Saudi Board of Orthodontic, Kingdom of Saudi Arabia
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Hayashi K, Iwasa K, Morinaga A, Ono K, Yamada M. Exacerbation of myasthenia gravis by intravenous peramivir. Muscle Nerve 2015; 51:935-6. [PMID: 25656959 DOI: 10.1002/mus.24594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Koji Hayashi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuo Iwasa
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Akiyoshi Morinaga
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenjiro Ono
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Tamburrini A, Tacconi F, Barlattani A, C. Mineo T. An update on myasthenia gravis, challenging disease for the dental profession. J Oral Sci 2015; 57:161-8. [DOI: 10.2334/josnusd.57.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Alessandro Tamburrini
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
| | - Federico Tacconi
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
| | | | - Tommaso C. Mineo
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
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Abstract
Antibiotic neurotoxicity is rare but can cause significant morbidity when it occurs. The risk of antibiotic neurotoxicity appears to be highest in patients who are older, have impaired renal function, or have preexisting neurologic conditions. This review describes the clinical features of the most common antibiotic toxicities affecting the nervous system: seizures, encephalopathy, optic neuropathy, peripheral neuropathy, and exacerbation of myasthenia gravis.
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Affiliation(s)
- Shamik Bhattacharyya
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA,
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Abstract
Compelling evidence of a cell surface receptor sensitive to extracellular calcium was observed as early as the 1980s and was finally realized in 1993 when the calcium-sensing receptor (CaR) was cloned from bovine parathyroid tissue. Initial studies relating to the CaR focused on its key role in extracellular calcium homeostasis, but as the amount of information about the receptor grew it became evident that it was involved in many biological processes unrelated to calcium homeostasis. The CaR responds to a diverse array of stimuli extending well beyond that merely of calcium, and these stimuli can lead to the initiation of a wide variety of intracellular signaling pathways that in turn are able to regulate a diverse range of biological processes. It has been through the examination of the molecular characteristics of the CaR that we now have an understanding of how this single receptor is able to convert extracellular messages into specific cellular responses. Recent CaR-related reviews have focused on specific aspects of the receptor, generally in the context of the CaR's role in physiology and pathophysiology. This review will provide a comprehensive exploration of the different aspects of the receptor, including its structure, stimuli, signalling, interacting protein partners, and tissue expression patterns, and will relate their impact on the functionality of the CaR from a molecular perspective.
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Affiliation(s)
- Aaron L Magno
- Department of Endocrinology and Diabetes, First Floor, C Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia
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Chen W, Bergsman JB, Wang X, Gilkey G, Pierpoint CR, Daniel EA, Awumey EM, Dauban P, Dodd RH, Ruat M, Smith SM. Presynaptic external calcium signaling involves the calcium-sensing receptor in neocortical nerve terminals. PLoS One 2010; 5:e8563. [PMID: 20052292 PMCID: PMC2797309 DOI: 10.1371/journal.pone.0008563] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 12/08/2009] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nerve terminal invasion by an axonal spike activates voltage-gated channels, triggering calcium entry, vesicle fusion, and release of neurotransmitter. Ion channels activated at the terminal shape the presynaptic spike and so regulate the magnitude and duration of calcium entry. Consequently characterization of the functional properties of ion channels at nerve terminals is crucial to understand the regulation of transmitter release. Direct recordings from small neocortical nerve terminals have revealed that external [Ca(2+)] ([Ca(2+)](o)) indirectly regulates a non-selective cation channel (NSCC) in neocortical nerve terminals via an unknown [Ca(2+)](o) sensor. Here, we identify the first component in a presynaptic calcium signaling pathway. METHODOLOGY/PRINCIPAL FINDINGS By combining genetic and pharmacological approaches with direct patch-clamp recordings from small acutely isolated neocortical nerve terminals we identify the extracellular calcium sensor. Our results show that the calcium-sensing receptor (CaSR), a previously identified G-protein coupled receptor that is the mainstay in serum calcium homeostasis, is the extracellular calcium sensor in these acutely dissociated nerve terminals. The NSCC currents from reduced function mutant CaSR mice were less sensitive to changes in [Ca(2+)](o) than wild-type. Calindol, an allosteric CaSR agonist, reduced NSCC currents in direct terminal recordings in a dose-dependent and reversible manner. In contrast, glutamate and GABA did not affect the NSCC currents. CONCLUSIONS/SIGNIFICANCE Our experiments identify CaSR as the first component in the [Ca(2+)](o) sensor-NSCC signaling pathway in neocortical terminals. Decreases in [Ca(2+)](o) will depress synaptic transmission because of the exquisite sensitivity of transmitter release to [Ca(2+)](o) following its entry via voltage-activated Ca(2+) channels. CaSR may detects such falls in [Ca(2+)](o) and increase action potential duration by increasing NSCC activity, thereby attenuating the impact of decreases in [Ca(2+)](o) on release probability. CaSR is positioned to detect the dynamic changes of [Ca(2+)](o) and provide presynaptic feedback that will alter brain excitability.
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Affiliation(s)
- Wenyan Chen
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jeremy B. Bergsman
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Xiaohua Wang
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Gawain Gilkey
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Carol-Renée Pierpoint
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Erin A. Daniel
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Emmanuel M. Awumey
- Julius L. Chambers Biomedical/Biotechnology Research Institute, North Carolina Central University, Durham, North Carolina, United States of America
| | - Philippe Dauban
- Centre National de la Recherche Scientifique, Institut de Chimie des Substances Naturelles, Gif-sur-Yvette, France
| | - Robert H. Dodd
- Centre National de la Recherche Scientifique, Institut de Chimie des Substances Naturelles, Gif-sur-Yvette, France
| | - Martial Ruat
- Centre National de la Recherche Scientifique, Institut de Neurobiologie Alfred Fessard, Gif-sur-Yvette, France
| | - Stephen M. Smith
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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