1
|
Cai Y, Cheng Z, Yang Y, Xu B, Feng Q, Liu X, Chen J, Zhou Q. Differentiation and characterization of non-thymomatous ocular myasthenia gravis children with CT. Acta Neurol Belg 2025; 125:149-156. [PMID: 39476226 DOI: 10.1007/s13760-024-02669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 10/15/2024] [Indexed: 03/05/2025]
Abstract
PURPOSE To compare thymic features using unenhanced computed tomography (CT) images between children with non-thymomatous ocular myasthenia gravis (OMG) and healthy children and determine the image feature cut-off values to allow differentiation of the two populations. METHODS We conducted a retrospective study involving 66 children who underwent chest CT, with 33 having non-thymomatous OMG and 33 healthy children without any abnormality. We recorded CT features of the thymus in each child, including the mean CT attenuation value, thymus area, area ratio, anteroposterior (AP) length, width (W), thickness (T), and transverse diameter (TD). These characteristics were analyzed to distinguish OMG from healthy controls. The receiver operating characteristic (ROC) analysis was used to clarify the best assessment, and the optimal cut-off values were determined. RESULTS The mean CT attenuation value, the thymus area, area ratio, and TD were significantly different (P < 0.05) between the two groups. The mean CT attenuation value was the most significant characteristic in differentiating OMG and healthy controls (area under the curve [AUC] = 0.70). Using 50.41 as the cut-off value for mean CT attenuation, a specificity of 0.70 and sensitivity of 0.82 was observed for distinguishing the two groups (P = 0.003). Optimal differentiation was achieved by combining more than one characteristic including CT attenuation, thymus area, and TD with an optional area ratio (AUC = 0.72). CONCLUSIONS Non-enhanced CT of the thymus complemented the clinical workup of children with non-thymomatous OMG. The cut-off values of the CT features may allow robust differentiation of OMG children.
Collapse
Affiliation(s)
- Youran Cai
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhongyuan Cheng
- Department of Radiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuanting Yang
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Baojun Xu
- Department of Radiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiwen Feng
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xu Liu
- Department of Radiology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jian Chen
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China.
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, No.613, Huangpu West Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| | - Qing Zhou
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou, China.
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, No.613, Huangpu West Road, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
2
|
Banerjee P, Alam MS, Hassan H. Reply to letter to the editor. Oman J Ophthalmol 2024; 17:418. [PMID: 39651518 PMCID: PMC11620305 DOI: 10.4103/ojo.ojo_304_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 10/04/2024] [Indexed: 12/11/2024] Open
Affiliation(s)
- Prabrisha Banerjee
- Department of Ophthalmology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Md. Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Haseeb Hassan
- Department of Neuromedicine, AMRI Hospitals, Kolkata, West Bengal, India
| |
Collapse
|
3
|
Nguyen TT, Chae J, Kang JJ, Oh SY. Saccadic fatigue as an early indicator for diagnosing myasthenia gravis. J Neurol 2024; 271:3631-3634. [PMID: 38402280 DOI: 10.1007/s00415-024-12262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Thanh Tin Nguyen
- Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Juhee Chae
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, Republic of Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
- Department of Neurology, Jeonbuk National University Hospital and School of Medicine, Jeonju, 54907, Republic of Korea.
- Jeonbuk National University and School of Medicine, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-712, Republic of Korea.
| |
Collapse
|
4
|
Kessi M, Tang Y, Chen B, Wang G, Zhang C, He F, Peng J, Yin F, Yang L. Pediatric Ocular Myasthenia Gravis: Single-Center Experience. Pediatr Neurol 2024; 153:137-143. [PMID: 38382246 DOI: 10.1016/j.pediatrneurol.2024.01.014] [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: 02/20/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and timing of treatment for pediatric OMG cases based on the clinical manifestations: OMG with ptosis only and OMG with other features. METHODS One hundred and forty two OMG cases attended at the Department of Pediatrics, Xiangya Hospital, Central South University, from 2010 to 2019 were included, and information from medical records was reviewed and recorded. Comparisons of clinical characteristics between patients with OMG with ptosis only and patients with OMG with other features as well as between patients treated with glucocorticoid (GC) within or after six months from disease onset were performed. RESULTS OMG with other features constituted about 54.9% of the cases, and 66.2% of the patients achieved optimal outcome. Patients with OMG with ptosis only responded to pyridostigmine alone more than patients with OMG with other features who required several therapies (P < 0.001). Patients with OMG with ptosis only had a larger proportion of optimal outcome than the patients with OMG with other features (P = 0.002), and the difference remained significant even when the individual outcome groups were compared (P < 0.001). Patients who received GC within six months had a greater proportion of optimal outcome than those who received it after six months (P < 0.001). CONCLUSIONS Although OMG with other features is a more common subtype of OMG, it is also more severe than OMG with ptosis only. An earlier addition of GC leads to optimal outcome.
Collapse
Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yulin Tang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Baiyu Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Guoli Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Ciliu Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
5
|
Mu Y, Huang X, Yang Y, Huang Z, Chen J, Li S, Dong Y, Chen F, Zhang R, Chen J, Feng H, Zhou Q. Study of serum exosome miRNA as a biomarker for early onset adult ouclar myastthenia gravis. Gene 2024; 896:148034. [PMID: 38013129 DOI: 10.1016/j.gene.2023.148034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND By extracting and sequencing miRNAs from serum exosomes of patients with early-onset ocular myasthenia gravis (OMG), generalized myasthenia gravis (GMG) and healthy controls, we screened differentially expressed miRNAs and explored the possibility as potential biomarkers for early-onset OMG. METHODS Peripheral blood samples were collected from patients with early-onset OMG, early-onset GMG, and age-matched healthy subjects, with 6 samples in each group. All these patients were diagnosed as MG for the first time and did not undergo any treatment. Exosomes miRNAs were extracted from the serum and performed deep sequencing; the differentially expressed miRNAs were compared and analyzed between OMG, GMG, and healthy control groups using edgeR. The differential expression standard was set to | log2FC |>1, p < 0.05. Target prediction of mRNAs were performed using miRTarBase, TargetScan, and miRDB databases, and a protein-protein interaction (PPI) network was constructed subsequently. The miRNAs with a significant difference were validated using RT-qPCR (10 early-onset OMG patients, 10 early-onset GMG patients and 10 age-sex-matched healthy subjects), and the value of the area under the ROC curve (AUC) was used to assess the diagnostic accuracy and evaluate clinical prognostic value. RESULTS In total, one upregulated (miR-130a-3p) miRNA was obtained through the upregulated intersection between control vs OMG and OMG vs GMG; four downregulated (miR-4712-3p; miR-6752-5p; miR-320d; miR-3614-3p) miRNAs were obtained through the downregulated intersection between control vs OMG and OMG vs GMG. A total of 408 target genes were predicted for the five differentially expressed miRNAs. The mTOR signaling pathway and Rap1 signaling pathway were significantly enriched based on the enrichment results. RT-qPCR findings revealed that for the OMG, the expression of miR-320d, miR-4712-3p and miR-3614-3p was markedly up-/down-regulated as compared to GMG and healthy control group. The AUC for the three miRNAs between OMG and healthy control groups were 0.78, 0.79 and 0.79 respectively; the AUC between OMG and GMG was 0.84. CONCLUSIONS The present study identified three novel miRNAs as candidate biomarkers for early-onset OMG patients and it was expected to provide a possibility and a new orientation for serum exosomal miRNAs as OMG diagnostic biomarkers.
Collapse
Affiliation(s)
- Yajun Mu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xin Huang
- Department of Neurology, The First Affiliated Hospital of Sun Yat sen University, Guangzhou, China
| | - Yuanting Yang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ziqing Huang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiaxin Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat sen University, Guangzhou, China
| | - Shiyin Li
- Department of Neurology, The First Affiliated Hospital of Sun Yat sen University, Guangzhou, China
| | - Yuying Dong
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fangyuan Chen
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rijia Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jian Chen
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat sen University, Guangzhou, China.
| | - Qing Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| |
Collapse
|
6
|
Zhang KY, Duan WW, Luo YB, Li Y, Hu J, Yang H. Comparative effectiveness and safety of intravenous methylprednisolone and tacrolimus monotherapy in ocular myasthenia gravis with unsatisfactory prednisone responses: a retrospective study. Orphanet J Rare Dis 2024; 19:19. [PMID: 38243274 PMCID: PMC10799357 DOI: 10.1186/s13023-024-03025-z] [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: 05/23/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Oral prednisone has been recognized as the first-line therapy for the treatment of ocular myasthenia gravis (OMG). However, its long-term use is complicated by numerous adverse effects and is ineffective for some OMG patients in reaching remission. This study aimed to evaluate the effectiveness and safety of intravenous methylprednisolone (IVMP) and tacrolimus monotherapy for OMG patients with unsatisfactory responses to conventional prednisone therapy. METHODS We retrospectively reviewed 57 OMG patients who had not achieved satisfactory improvement after prednisone therapy and thereby received IVMP or tacrolimus monotherapy for at least 6 months. Ocular symptoms were evaluated by the ocular-quantitative MG (QMG) score at each time point. A ≥ 2-point fall in ocular QMG score was defined as the cut-off point to indicate clinical improvement. Logistic regression analysis was performed to identify factors associated with the efficacy of IVMP at discharge. Adverse events were recorded. RESULTS Both IVMP and tacrolimus monotherapy demonstrated significant clinical efficacy, with no statistical differences observed at the study endpoint. The proportions of patients who reached the cut-off point for efficacy evaluation were higher in the IVMP group than in the tacrolimus group (1, 3, and 6 months: 51.7% (15/29) vs 12.0% (3/25), p = 0.002; 69.0% (20/29) vs 40.0% (10/25), p = 0.033; 69.0% (20/29) vs 46.4% (13/28), p = 0.085, respectively). Multivariate logistics analysis showed that high ocular QMG scores at baseline indicated favourable responses to IVMP treatment (OR = 1.781; 95% CI 1.066-2.975; p = 0.028). All the adverse events were transient and tolerable. CONCLUSION Our findings suggest that both IVMP and tacrolimus monotherapy hold promise as viable treatment options for OMG patients with unsatisfactory responses to oral prednisone. The study supports the safety and effectiveness of both therapies, with IVMP exhibiting faster improvement and favourable efficacy in patients with high ocular QMG scores.
Collapse
Affiliation(s)
- Kai-Yue Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, China
| | - Wei-Wei Duan
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, China
| | - Yue-Bei Luo
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, China
| | - Yi Li
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, China
| | - Jue Hu
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, 410008, China.
| |
Collapse
|
7
|
Sergeeva MS, Danilov SS, Sherbakova NI. [Ocular myasthenia gravis]. Vestn Oftalmol 2024; 140:86-91. [PMID: 39254395 DOI: 10.17116/oftalma202414004186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Myasthenia gravis is an autoimmune disease characterized by muscle weakness and pathological fatigue due to autoaggressive phenomena with the formation of antibodies directed against various structures of the neuromuscular synapse. In most patients, the disease begins with the involvement of extraocular muscles, presenting with symptoms such as intermittent ptosis of the upper eyelid and/or binocular diplopia. In 15% of cases, clinical manifestations are limited to impairment of the levator palpebrae superioris and extraocular muscles, characteristic of the ocular form of myasthenia gravis. Specialists often encounter challenges in diagnosing this form, as serological and electrophysiological studies may be uninformative, necessitating diagnosis based on patient history and clinical picture. This literature review outlines the key aspects of the pathogenesis, clinical manifestations, methods of diagnosis and treatment of ocular myasthenia gravis.
Collapse
Affiliation(s)
- M S Sergeeva
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - S S Danilov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - N I Sherbakova
- P. Hertsen Moscow Oncology Research Institute - branch of the National Medical Research Radiological Centre, Russia, Moscow
| |
Collapse
|
8
|
Bi Z, Cao Y, Gui M, Lin J, Zhang Q, Li Y, Ji S, Bu B. Dynamic nomogram for predicting generalized conversion in adult-onset ocular myasthenia gravis. Neurol Sci 2023; 44:1383-1391. [PMID: 36469201 PMCID: PMC10023757 DOI: 10.1007/s10072-022-06519-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To explore the factors and risk mapping model of progression from ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) in adult-onset patients. METHODS A retrospective, observational cohort study was performed for 435 OMG patients with onset age older than 14 years old. Multivariate Cox regression was used to identify the independent factors affecting generalized conversions that then were incorporated into the construction of the nomogram. RESULTS Two hundred thirty-seven patients (54.5%) had transformed into GMG after a median of 1.1 years (range 0.1--9.1 years). The 6-, 12-, and 24-month generalized conversion rates were 31.7%, 49.8%, and 65.4%, respectively. Multivariable analysis showed that the early-onset age, male sex, concomitant autoimmune diseases (AID), positive results of anti-acetylcholine receptor antibodies, repetitive nerve stimulation abnormalities, the presence of thymoma, and prednisone treatment were significantly associated with the generalized conversions (hazard ratio [HR] = 0.598, 0.686, 1.554, 1.541, 2.020, 2.510, and 0.556, respectively). A nomogram was established to predict the possibility of generalization-free survival (GFS) in adult-onset OMG patients, and the model demonstrated good predictive performance with a C-index of 0.736 (95% confidence interval 0.703 ~ 0.769). Moreover, subgroup analyses were performed based on the presence or absence of prednisone therapy, and the results indicated that prednisone therapy has better prevention of generalized conversions in male, non-thymoma patients, and patients without other AID. CONCLUSION A new predictive nomograph and web-based survival calculator we developed show favorable applicability and accuracy in predicting long-term GFS in adult-onset OMG patients.
Collapse
Affiliation(s)
- Zhuajin Bi
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yayun Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mengcui Gui
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Suqiong Ji
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| |
Collapse
|
9
|
Keene KR, de Nie JM, Brink MJ, Notting IC, Verschuuren JJGM, Kan HE, Beenakker JWM, Tannemaat MR. Diagnosing myasthenia gravis using orthoptic measurements: assessing extraocular muscle fatiguability. J Neurol Neurosurg Psychiatry 2023; 94:151. [PMID: 36261286 DOI: 10.1136/jnnp-2022-329859] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Diagnosing ocular myasthenia gravis (MG) can be challenging because serum antibodies are often not detected. We aimed to explore whether determining extraocular muscle (EOM) weakness using orthoptic measures, including an adapted Hess chart examination, can aid in diagnosing MG. METHODS We conducted a prospective study among patients with acetylcholine receptor antibody positive MG (20 recently diagnosed, 19 chronic) and 14 seronegative MG patients. We compared orthoptic measures to 19 healthy and 18 disease controls with Graves orbitopathy, chronic progressive external ophthalmoplegia or oculopharyngeal muscular dystrophy. Maximal eye duction angles were measured using a synoptophore. Gaze deviations between eyes were measured using standard Hess chart examination with addition of 1 min persistent gaze to assess MG-associated fatiguability. Receiver operating characteristics curve analysis was performed. RESULTS For duction angles, the area under the curve (AUC) was 0.73 comparing MG to healthy, and 0.69 comparing to patient controls. For the outer field of the Hess chart, the AUC was 0.89 comparing to healthy and 0.54 to patient controls. For drift, the AUC was 0.93 comparing to healthy and 0.93 to patient controls. The sensitivity and specificity of the presence of drift was 81% and 100%. DISCUSSION Orthoptic measurements can be used to diagnose MG by quantifying EOM weakness and fatiguability. Drift during persistent gaze on a Hess chart is specific for MG and could be used for diagnostic purposes. The Hess chart examination is widely available, inexpensive and fast. Moreover, orthoptic measurements may be a clinically relevant outcome measure for clinical trials.
Collapse
Affiliation(s)
- Kevin R Keene
- CJ Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan M de Nie
- Department of Ophthalmology, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Mechteld J Brink
- Department of Ophthalmology, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Irene C Notting
- Department of Ophthalmology, Leiden University Medical Centrum, Leiden, The Netherlands
| | | | - Hermien E Kan
- CJ Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- CJ Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Leiden University Medical Centrum, Leiden, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
10
|
Point Counter-Point: Thymectomy in Ocular Myasthenia Gravis. J Neuroophthalmol 2022; 42:541-546. [PMID: 36394968 DOI: 10.1097/wno.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Abstract
Myasthenia gravis is a rare autoimmune disease characterised by autoantibodies preventing normal function of acetylcholine receptors at the post-synaptic membrane of the neuromuscular junction. This causes weakness of skeletal muscles that can be variable and fatigable, and often manifests as ptosis and/or diplopia, with 60% of patients demonstrating ocular features at onset, and thus may present initially to eye care practitioners. Approximately 15% of patients have ocular myasthenia gravis, where symptoms remain restricted to this distribution. The majority of patients have blocking antibodies against the acetylcholine receptor, but antibodies directed against other related targets account for a smaller proportion and are associated with specific phenotypes. Associations with both thymoma and with other autoimmune phenomena (particularly thyroid disease) can occur. Clinical examination can identify characteristic findings including fatigable ptosis and Cogan's lid twitch sign. Investigations to confirm the diagnosis include simple office-based procedures such as the ice test, and testing for serum autoantibodies, as well as electrophysiological testing such as repetitive nerve stimulation and single-fibre electromyography. The management of ocular myasthenia gravis is discussed, including non-pharmacological options, pyridostigmine, corticosteroids, other immunosuppressive agents, and thymectomy. The goals of management are to alleviate symptoms, and where possible prevent chronic disability or progression to generalised myasthenia gravis.
Collapse
Affiliation(s)
- Neil H Shuey
- Neuro-ophthalmology Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Clinical Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, Australia
| |
Collapse
|
12
|
Guo RJ, Gao T, Ruan Z, Zhou HY, Gao F, Xu Q, Yu LP, Wu SD, Lei T, Li HH, Sun C, Zhang M, Gao YW, Lu XD, Tang YL, Tang BL, Huo FY, Zhu Y, Li ZY, Chang T. Risk Factors for Generalization in Patients with Ocular Myasthenia Gravis: A Multicenter Retrospective Cohort Study. Neurol Ther 2021; 11:73-86. [PMID: 34729706 PMCID: PMC8857387 DOI: 10.1007/s40120-021-00292-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
Introduction Many patients with ocular myasthenia gravis (OMG) progress to generalized disease within the first 2 years of the onset of ocular symptoms. Several retrospective studies have identified risk factors associated with generalization, however these studies included patients on immunosuppression therapy or those undergoing thymectomy, which may reduce the generalization risk. In this study we explored the risk factors for generalization in non-immunosuppressed and non-thymectomized patients with OMG. Methods Data from patients with OMG treated at seven tertiary hospitals in China were retrospectively reviewed. Clinical characteristics, including sex, age at onset, symptoms at onset, comorbid autoimmune diseases, neostigmine test response, repetitive nerve stimulation (RNS) findings, presence of serum anti-acetylcholine receptor antibody (AChR-Ab), and thymic status based on radiological and pathological studies, were collected. The main outcome measure was disease generalization. The follow-up period was defined as the date of ocular symptom onset to the date of confirmation of generalization or immunotherapy initiation, or last follow-up (defined as 60 months). The Cox proportional hazards model was used to assess the risk factors for generalization. Results Overall, 572 patients (269 women) were eligible for inclusion in the analysis, of whom 144 developed generalization. The mean (standard deviation) onset age was 45.5 (19.8) years, and the median (interquartile range) follow-up period was 14.5 (7.0–47.3) months. Multivariable Cox regression analysis demonstrated that both early-onset (adjusted hazard ratio [aHR] 5.34; 95% confidence interval [CI] 1.64–17.36; p = 0.005) and late-onset (aHR 7.18; 95% CI 2.22–23.27; p = 0.001) in adulthood, abnormal RNS findings (aHR 3.01; 95% CI 1.97–4.61; p < 0.001), seropositivity for AChR-Ab (aHR 2.58; 95% CI 1.26–5.26; p = 0.01), and thymoma (aHR 1.62; 95% CI 1.05–2.49; p = 0.03) were independently associated with increased risk of generalization. Conclusion The risk of generalization increased significantly in patients with adult-onset OMG, abnormal RNS findings, seropositivity for AChR-Ab, and thymoma, suggesting that these risk factors may predict OMG generalization. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00292-x.
Collapse
Affiliation(s)
- Rong-Jing Guo
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Ting Gao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Hong-Yu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Gao
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Li-Ping Yu
- Department of Neurology, Xianyang First People's Hospital, Xianyang, China
| | - Song-Di Wu
- Department of Neurology, Xi'an No.1 Hospital, Xi'an, China
| | - Tao Lei
- Department of Neurology, Xi'an Fourth Hospital, Xi'an, China
| | - Huan-Huan Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Chao Sun
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Min Zhang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Yan-Wu Gao
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Xiao-Dan Lu
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Yong-Lan Tang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Bao-Li Tang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Fei-Yan Huo
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Ying Zhu
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Zhu-Yi Li
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China.
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China.
| |
Collapse
|
13
|
Bongers J, Gutierrez‐Quintana R, Stalin CE. External ophthalmoparesis as part of generalised myasthenia gravis in a dog: are there more similarities to the human counterpart than originally thought? VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jos Bongers
- School of Veterinary Medicine University of Glasgow Glasgow UK
| | | | | |
Collapse
|
14
|
Clinical features and treatment status of antiacetylcholine receptor antibody-positive ocular myasthenia gravis. Jpn J Ophthalmol 2020; 64:628-634. [PMID: 32936398 DOI: 10.1007/s10384-020-00770-z] [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: 01/28/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To clarify the factors predictive of progression from ocular myasthenia gravis (OMG) to generalized MG (GMG) among patients with positive antiacetylcholine receptor antibodies (AChRAb) and to evaluate the efficacy of our OMG treatment protocol including tacrolimus (TAC). STUDY DESIGN Retrospective study. METHODS Fifty-two patients with AChRAb positivity and ptosis and/or eye movement disturbance showing diurnal fluctuation and fatigability were included. First, we compared the clinical characteristics of patients without OMG progression (p-OMG) with those of patients whose OMG transformed to GMG (TMG). Second, we subdivided the p-OMG patients according to the time of approval of TAC into the Before group and the After group. We compared the dosage and period of prednisolone administration (PSL) of the 2 groups. Third, we evaluated the responses to OMG treatment using the Myasthenia Gravis Foundation of America Postintervention Status (MGFA-PS) scale. RESULTS Forty-one patients were classified into the p-OMG group, and 11, into the TMG group. The AChRAb level (P = 0.0006) and prevalence of thymoma (P = 0.001) were significantly higher in the TMG group than in the p-OMG group. In the p-OMG group, the MG composite score (P ≤ 0.0001) and AChRAb level (P = 0.005) improved after treatment. The periods of PSL administration at ≥ 20 mg/day (P = 0.009) and at 10 to 19 mg/day (P = 0.002) were significantly shorter in the After group. At the last follow-up, 78.0% of the p-OMG group patients had achieved MGFA-PS minimal manifestations or better status with PSL ≤ 5 mg/day. CONCLUSIONS The TMG cases were characterized by higher AChRAb levels and presence of thymoma. The P-OMG patients could be managed with our treatment protocol. Combined use of TAC was efficacious in patients with steroid-dependent p-OMG.
Collapse
|