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Bhandage AK, Kenina V, Huang YF, Roddate M, Kauke G, Grosmane A, Žukova V, Eriksson N, Gabrysch K, Punga T, Punga AR. Serum protein biomarker profile distinguishes acetylcholine receptor antibody seropositive myasthenia gravis patients from healthy controls. iScience 2024; 27:110564. [PMID: 39165841 PMCID: PMC11334828 DOI: 10.1016/j.isci.2024.110564] [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: 01/05/2024] [Revised: 05/13/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024] Open
Abstract
There is an unmet need for objective disease-specific biomarkers in the heterogeneous autoimmune neuromuscular disorder myasthenia gravis (MG). This cross-sectional study identified a signature of 23 inflammatory serum proteins with proximity extension assay (PEA) that distinguishes acetylcholine receptor antibody seropositive (AChR+) MG patients from healthy controls (HCs). CCL28, TNFSF14, 4E-BP1, transforming growth factor alpha (TGF-α), and ST1A1 ranked top biomarkers. TGF-β1 and osteoprotegerin (OPG) differed between early- and late-onset MG, whereas CXCL10, TNFSF14, CCL11, interleukin-17C (IL-17C), and TGF-α differed significantly with immunosuppressive treatment. MG patients with moderate to high disease severity had lower uPA. Previously defined MG-associated microRNAs, miR-150-5p, miR-30e-5p, and miR-21-5p, correlated inversely with ST1A1 and TNFSF14. The presented inflammatory proteins that distinguish AChR+ MG are promising serum biomarkers for validation in prospective studies to allow for molecular signatures for patient subgroup stratification and monitoring of treatment response.
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Affiliation(s)
- Amol K. Bhandage
- Department of Medical Sciences, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Viktorija Kenina
- Department of Neurology, Paul Stradinš Clinical University Hospital, Riga, Latvia
- Department of Neurology, Riga Stradinš University, Riga, Latvia
| | - Yu-Fang Huang
- Department of Medical Sciences, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Marija Roddate
- Department of Neurology, Paul Stradinš Clinical University Hospital, Riga, Latvia
- Department of Neurology, Riga Stradinš University, Riga, Latvia
| | - Gundega Kauke
- Department of Neurology, Paul Stradinš Clinical University Hospital, Riga, Latvia
| | - Arta Grosmane
- Department of Neurology, Riga Stradinš University, Riga, Latvia
| | - Violeta Žukova
- Department of Neurology, Paul Stradinš Clinical University Hospital, Riga, Latvia
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Katja Gabrysch
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tanel Punga
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Anna Rostedt Punga
- Department of Medical Sciences, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
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Tan JY, Tan CY, Gengadharan PN, Shahrizaila N, Goh KJ. Clinical Characteristics and Outcomes of Generalized Myasthenia Gravis in Malaysia: A Single-Center Experience. J Clin Neurol 2024; 20:412-421. [PMID: 38951974 PMCID: PMC11220361 DOI: 10.3988/jcn.2023.0285] [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: 07/30/2023] [Revised: 11/18/2023] [Accepted: 12/30/2023] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Myasthenia gravis (MG) is clinically heterogeneous and can be classified into subgroups according to the clinical presentation, antibody status, age at onset, and thymic abnormalities. This study aimed to determine the clinical characteristics and outcomes of generalized MG (GMG) patients based on these subgroups. METHODS Medical records of MG patients from 1976 to 2023 were reviewed retrospectively. Patients with pure ocular MG were excluded. Data on demographic, clinical characteristics, laboratory features, and outcomes were analyzed. RESULTS This study included 120 GMG patients. There was a slight preponderance of female patients over male patients (male:female ratio=1:1.3), with the age at onset exhibiting a bimodal distribution. Female patients peaked at a lower age (21-30 years) whereas male patients peaked at a higher age (61-70 years). Most (92%, 105 of 114) patients had positive anti-acetylcholine receptor antibodies. Five patients were also tested for anti-muscle-specific tyrosine kinase antibodies, with two showing positivity. Thymectomy was performed in 62 (52%) patients, of which 30 had thymoma, 16 had thymic hyperplasia, 7 had an involuted thymus, and 6 had a normal thymus. There were significantly more female patients (68% vs. 45%, p=0.011) with early-onset disease (<50 years old) and thymic hyperplasia (33% vs. 0%, p<0.025). Most (71%) of the patients had a good outcome based on the Myasthenia Gravis Foundation of America postintervention status. GMG patients with early-onset disease had a significantly better outcome than patients with a late onset in univariate (58% vs. 37%, p=0.041) and multivariate (odds ratio=4.68, 95% confidence interval=1.17-18.64, p=0.029) analyses. CONCLUSIONS Female patients with early-onset MG and thymic hyperplasia had significantly better outcomes, but only early-onset disease was independently associated with a good outcome. These findings are comparable with those of other studies.
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Affiliation(s)
- Jie Ying Tan
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng Yin Tan
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Prasana Nair Gengadharan
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Liu X, Li R, Li W, Liu W, Wang J, Jing Y. The rate of QMGS change predicts recurrence after thymectomy in myasthenia gravis. J Clin Neurosci 2024; 124:20-26. [PMID: 38640804 DOI: 10.1016/j.jocn.2024.04.011] [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] [Received: 10/26/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To investigate the relationship between short-term changes in quantitative myasthenia gravis score (QMGS) after thymectomy and postoperative recurrence in myasthenia gravis (MG) patients without thymoma. METHODS A retrospective observational cohort study. The QMGS of 44 patients with non-thymomatous MG were evaluated before and 1 month after thymectomy, and the frequency and time of postoperative recurrence were recorded. The reduction rate of QMGS (rr-QMGS) was defined as (QMGS one week before thymectomy - QMGS one month after thymectomy)/ QMGS one week before thymectomy × 100 %, as an indicator of short-term symptom change after thymectomy. The receiver operating characteristic (ROC) curve was established to determine an appropriate cut-off value of rr-QMGS for distinguishing postoperative recurrence. Multivariate Cox regression analysis was applied to predict postoperative recurrence. RESULTS Postoperative recurrence occurred in 21 patients (30 times in total) during follow-up. The mean annual recurrence rate was 3.98 times/year preoperatively and 0.30 times/year postoperatively. ROC analysis determined the cut-off value of rr-QMGS was 36.7 % (sensitivity 90.5 %, specificity 52.2 %). Multivariate Cox regression analysis showed that rr-QMGS<36.7 % (hazard rate[HR]6.251, P = 0.014) is positive predictor of postoperative recurrence. Kaplan-Meier analysis showed that postoperative recurrence time was earlier in the low rr-QMGS group than in the high rr-QMGS group (12.62 vs. 36.60 months, p = 0.005). CONCLUSIONS Low rr-QMGS is associated with early postoperative recurrence. Rr-QMGS can be used to predict postoperative recurrence of non-thymomatous MG.
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Affiliation(s)
- Xinxin Liu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ran Li
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wenwen Li
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wei Liu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yun Jing
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Cai Q, Batista AE, Börsum J, Zhang Q, Isheden G, Kunovszki P, Gandhi K, Heerlein K, Brauner S. Long-Term Healthcare Resource Utilization and Costs among Patients with Myasthenia Gravis: A Swedish Nationwide Population-Based Study. Neuroepidemiology 2024:1-10. [PMID: 38631321 DOI: 10.1159/000538640] [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: 09/27/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Healthcare costs and societal impact of myasthenia gravis (MG), a potentially life-threatening rare, chronic neuromuscular disease, are sparsely studied. We assessed healthcare resource utilization (HCRU) and associated costs among patients with newly diagnosed (ND) and preexisting (PE) MG in Sweden. METHODS This observational, retrospective cohort study used data from four linkable Swedish nationwide population-based registries. Adult MG patients receiving pharmacological treatment for MG and having ≥24-month follow-up during the period January 1, 2010, to December 31, 2017, were included. RESULTS A total of 1,275 patients were included in the analysis, of which 554 patients were categorized into the ND MG group and 721 into the PE MG group. Mean (±SD) age was 61.3 (±17.4) years, and 52.3% were female. In the first year post-diagnosis, ND patients had significantly higher utilization of acetylcholinesterase inhibitors (96.0% vs. 83.9%), corticosteroids (59.6% vs. 45.8%), thymectomy (12.1% vs. 0.7%), and plasma exchange (3.8% vs. 0.6%); had higher all-cause (70.9% vs. 35.8%) and MG-related (62.5% vs. 18.4%) hospitalization rates with 11 more hospitalization days (all p < 0.01) and an increased risk of hospitalization (odds ratio [95% CI] = 4.4 [3.43, 5.64]) than PE MG. In year 1 post-diagnosis, ND MG patients incurred EUR 7,302 (p < 0.01) higher total all-cause costs than PE MG, of which 84% were estimated to be MG-related and the majority (86%) were related to inpatient care. These results remained significant also after controlling for baseline demographics and comorbidities (p < 0.01). In year 2 post-diagnosis, the all-cause medical costs decreased by ∼55% for ND MG from year 1 and were comparable with PE MG. CONCLUSION In this population-based study, MG patients required significantly more healthcare resources in year 1 post-diagnosis than PE MG primarily due to more pharmacological treatments, thymectomies, and associated hospitalizations. These findings highlight the need to better understand potential factors including disease characteristics associated with increased health resource use and costs and need for more efficacious treatments early in the disease course.
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Affiliation(s)
- Qian Cai
- Janssen Global Services, Titusville, New Jersey, USA
| | | | | | - Qiaoyi Zhang
- Janssen Global Services, Titusville, New Jersey, USA
| | | | | | - Kavita Gandhi
- Janssen Global Services, Titusville, New Jersey, USA
| | | | - Susanna Brauner
- Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Chanson JB, Bouhour F, Aubé-Nathier AC, Mallaret M, Vial C, Hacquard A, Petiot P, Spinazzi M, Nadaj-Pakleza A, Echaniz-Laguna A. Myasthenia gravis treatment in the elderly presents with a significant iatrogenic risk: a multicentric retrospective study. J Neurol 2023; 270:5819-5826. [PMID: 37592137 DOI: 10.1007/s00415-023-11925-6] [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] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disease treated with acetylcholinesterase inhibitors and immunosuppressant/immunomodulatory drugs. MG is frequently diagnosed in elderly patients, a fragile population in which treatment adverse effects (TAE) have not been evaluated until now. METHODS We retrospectively analysed the files of all MG patients with disease onset after age 70 years in four French University Hospitals, including clinical, electrophysiological, biological, and treatment data, with an emphasis on TAE. MG outcomes were assessed using the Myasthenia Gravis Foundation of America (MGFA) status scale. RESULTS We included 138 patients (59% of men) with a mean follow-up of 4.5 years (range 1-19). Mean age at diagnosis was 78 years (70-93). Anti-acetylcholine receptor antibodies were found in 87% of cases, electrophysiological abnormalities in 82%, and thymoma in 10%. MG outcome was good in a majority of cases, with 76% of treated patients presenting with alleviated symptoms at follow-up. TAE were observed in 41% of patients, including severe TAE in 14% of cases. Seven patients (5.1%) died, including four (2.9%) from MG-related respiratory failure, and three (2.2%) from MG treatment-related complications, i.e., sepsis in 2 cases and brain toxoplasmosis in 1 case. TAE were observed in 53% of patients treated with azathioprine, 23% of patients treated with corticosteroids, and 15% of patients treated with mycophenolate mofetil. CONCLUSIONS This retrospective study demonstrates MG in the elderly presents with a significant iatrogenic risk, including fatal immunosuppressant-related infections.
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Affiliation(s)
- Jean-Baptiste Chanson
- Service de Neurologie, Centre de Référence Neuromusculaire Nord/Est/Ile de France, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
- ERN EURO-NMD, Paris, France.
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg et Centre de Référence Neuromusculaire Nord/Est/Ile de France, 1 Avenue Molière, 67091, Strasbourg Cedex, France.
| | | | | | - Martial Mallaret
- Service de Neurologie, Hôpital La Tronche, CHU Grenoble, Grenoble, France
| | - Christophe Vial
- Service de Neurologie, Hôpital Wertheimer, CHU Lyon, Lyon, France
| | | | - Philippe Petiot
- Service de Neurologie, Hôpital Wertheimer, CHU Lyon, Lyon, France
| | | | - Aleksandra Nadaj-Pakleza
- Service de Neurologie, Centre de Référence Neuromusculaire Nord/Est/Ile de France, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- ERN EURO-NMD, Paris, France
| | - Andoni Echaniz-Laguna
- ERN EURO-NMD, Paris, France
- Neurology Department, APHP, CHU de Bicêtre, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (NNERF), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
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Huang X, Zhang Z, Wang Y, Xu M, Du X, Zhang Y. Circulating miRNAs drive personalized medicine based on subgroup classification in myasthenia gravis patients. Neurol Sci 2023; 44:3877-3884. [PMID: 37402938 DOI: 10.1007/s10072-023-06933-3] [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] [Received: 12/25/2022] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
Myasthenia gravis (MG) is a classic autoimmune neuromuscular disease with strong clinical heterogeneity. The concept of subgroup classification was proposed to guide the precise treatment of MG. Subgroups based on serum antibodies and clinical features include ocular MG, early-onset MG with AchR antibodies, late-onset MG with AchR antibodies, thymoma-associated MG, MuSK-associated MG, LRP4-associated MG, and seronegative MG. However, reliable objective biomarkers are still needed to reflect the individualized response to therapy. MicroRNAs (miRNAs) are small non-coding RNA molecules which can specifically bind to target genes and regulate gene expression at the post-transcriptional level, and then influence celluar biological processes. MiRNAs play an important role in the pathogenesis of autoimmune diseases, including MG. Several studies on circulating miRNAs in MG have been reported. However, there is rare systematic review to summarize the differences of these miRNAs in different subgroups of MG. Here, we summarize the potential role of circulating miRNAs in different subgroups of MG to promote personalized medicine.
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Affiliation(s)
- Xiaoyu Huang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhouao Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China
| | - Yingying Wang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China
| | - Mingming Xu
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China
| | - Xue Du
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China
| | - Yong Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan Distric, Xuzhou, Jiangsu, China.
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Kemchoknatee P, Armornpetchsathaporn A, Tangon D, Srisombut T. Age of onset and factors affecting treatment responses in ocular myasthenia gravis. Int Ophthalmol 2023; 43:2777-2785. [PMID: 36879110 DOI: 10.1007/s10792-023-02676-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Ocular myasthenia gravis (OMG) is an autoimmune disease which causes ptosis, diplopia, or both. It can be categorized as early or late onset, with differing presenting characteristics and prognoses. Currently, there is limited information available to compare characteristics and outcomes in onset groups in Thailand. OBJECTIVE To describe and compare baseline characteristics and outcomes in OMG patients classified by onset groups and to investigate the factors associated with the disease, especially in terms of treatment responses classified according to the MGFA Post-Intervention Status (MGFA-PIS). METHODS OMG patients diagnosed between January 2014 and March 2021 at Rajavithi Hospital, Thailand, were categorized into 2 groups based on age of onset, and baseline characteristics were analyzed and compared. The treatment responses of each group in terms of time to achievement of minimal manifestations (MM) were analyzed. RESULTS Eighty-one patients (38 with early and 43 with late onset) were included, and the mean (SD) follow-up time was 35.85 months (17.25). There was no significant difference between the baseline characteristics of the two groups. A low dose of pyridostigmine was more commonly used in the early-onset group (p = 0.01), while the mean dose of corticosteroids was significantly lower in the late-onset patients (p < 0.001). We found that seropositivity of acetylcholine receptor antibody decreased the odds ratio of achievement of MM (OR 0.185, 95% CI 0.043-0.789, p = 0.023) and receiving a high dose of pyridostigmine (≥ 120 mg/day) increased the odds ratio of achieving it (OR 8.296, 95% CI 2.136-32.226, p = 0.002). CONCLUSIONS A higher dose of pyridostigmine may be necessary for achievement of favorable treatment response. AChRAb seropositivity is a predictor for unfavorable treatment response in Thai populations.
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Affiliation(s)
- Parinee Kemchoknatee
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2 Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Anyarak Armornpetchsathaporn
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2 Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Duanghathai Tangon
- Faculty of Medicine Rajavithi Hospital, Rangsit University, 2 Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Thansit Srisombut
- Department of Ophthalmology, Rangsit University, Rajavithi Hospital, 2 Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
- Faculty of Medicine Rajavithi Hospital, Rangsit University, 2 Phaya Thai Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
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Croitoru CG, Cuciureanu DI, Hodorog DN, Grosu C, Cianga P. Autoimmune myasthenia gravis and COVID-19. A case report-based review. J Int Med Res 2023; 51:3000605231191025. [PMID: 37565671 PMCID: PMC10422912 DOI: 10.1177/03000605231191025] [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: 04/22/2022] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
A potential relationship between COVID-19 infection and new onset myasthenia gravis (MG) has been suggested by the coexistence of these two diseases in a number of reports. This study aimed to assess their relationship by reviewing case studies of COVID-19 followed by new onset MG published between 01 December 2019 and 30 June 2023 identified by a search of PubMed/Medline database. In addition, we reviewed evidence in favour and against a potential cause and effect association, and described possible mechanisms that would underpin such a relationship. We identified 14 publications that reported 18 cases. Analysis showed the following features: age 19-83 years; 10 men/8 women; median time interval between COVID-19 and MG (17, 5-56 days); autoimmune comorbidities (4); generalised MG (14); ocular MG (4); thymoma (3); antiacetylcholine receptor antibody (16); antimuscle-specific kinase antibodies (2). All patients improved following treatment. Proof of direct causality between the two conditions can only be established in time by confirming epidemiological increase in the incidence of MG or elucidating pathogenic mechanisms to substantiate a possible cause-effect association, or both.
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Affiliation(s)
- Cristina Georgiana Croitoru
- Department of Immunology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
- Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iași, Romania
| | - Dan Iulian Cuciureanu
- Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iași, Romania
- Department Medical III, Department of Neurology,” Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Diana Nicoleta Hodorog
- Neurology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iași, Romania
- Department Medical III, Department of Neurology,” Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Cristina Grosu
- Department Medical III, Department of Neurology,” Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
| | - Petru Cianga
- Department of Immunology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
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Sun T, Zhao D, Zhang G, Huang Y, Guo J, Jiang W, Jia R, Maimaiti M, Liu J, Bu N, Li Z, Yan Y, Zhang X, Sun C, Zhao C, Jia X, Mao B, Tian H, Liu Y, Chen Z, Fan Z, Guo X, Lu J, Ren K, Li H, Guo J. Late-Onset Anti-GABA B Receptor Encephalitis: Clinical Characteristics and Outcomes Differing From Early-Onset Patients. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200131. [PMID: 37230544 DOI: 10.1212/nxi.0000000000200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Existing evidence indicates anti-GABAB receptor encephalitis (GABABR-E) seems to occur more commonly later in life, yet the age-associated differences in clinical features and outcomes are not well determined. This study aims to explore the demographic, clinical characteristics, and prognostic differences between late-onset and early-onset GABABR-E and identify predictors of favorable long-term outcomes. METHODS This is an observational retrospective study conducted in 19 centers from China. Data from 62 patients with GABABR-E were compared between late-onset (aged 50 years or older) and early-onset (younger than 50 years) groups and between groups with favorable outcomes (modified Rankin scale (mRS) ≤ 2) and poor outcomes (mRS >2). Logistic regression analyses were applied to identify factors affecting long-term outcomes. RESULTS Forty-one (66.1%) patients experienced late-onset GABABR-E. A greater proportion of males, a higher mRS score at onset, higher frequencies of ICU admission and tumors, and a higher risk of death were demonstrated in the late-onset group than in the early-onset group. Compared with poor outcomes, patients with favorable outcomes had a younger onset age, a lower mRS score at onset, lower frequencies of ICU admission and tumors, and a greater proportion with immunotherapy maintenance for at least 6 months. On multivariate regression analysis, age at onset (OR, 0.849, 95% CI 0.739-0.974, p = 0.020) and the presence of underlying tumors (OR, 0.095, 95% CI 0.015-0.613, p = 0.013) were associated with poorer long-term outcomes, whereas immunotherapy maintenance for at least 6 months was associated with favorable outcomes (OR, 10.958, 95% CI 1.469-81.742, p = 0.020). DISCUSSION These results demonstrate the importance of risk stratification of GABABR-E according to age at onset. More attention should be paid to older patients especially with underlying tumors, and immunotherapy maintenance for at least 6 months is recommended to achieve a favorable outcome.
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Affiliation(s)
- Tangna Sun
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daidi Zhao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gejuan Zhang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Huang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jia Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Wen Jiang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rui Jia
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Maynur Maimaiti
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianguo Liu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ning Bu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zunbo Li
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaping Yan
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyan Zhang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chenjing Sun
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cong Zhao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaotao Jia
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Baoyi Mao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hui Tian
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Liu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zheng Chen
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zilian Fan
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyan Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jiarui Lu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kaixi Ren
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongzeng Li
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jun Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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10
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Tang YL, Ruan Z, Su Y, Guo RJ, Gao T, Liu Y, Li HH, Sun C, Li ZY, Chang T. Clinical Characteristics and Prognosis of Very late-onset Myasthenia Gravis in China. Neuromuscul Disord 2023; 33:358-366. [PMID: 36990040 DOI: 10.1016/j.nmd.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
Alteration in onset-age distribution in myasthenia gravis (MG) and its increasing prevalence among the elderly underscores the need for a better understanding of the clinical course of MG and the establishment of personalized treatment. In this study we reviewed the demographics, clinical profile, and treatment of MG. Based on onset age, eligible patients were classified as early-onset MG (onset age ≥18 and <50 years), late-onset MG (onset age ≥50 and <65 years), and very late-onset MG (onset age ≥65 years). Overall, 1160 eligible patients were enrolled. Patients with late- and very late-onset MG showed a male predominance (P=0.02), ocular MG subtype (P=0.001), and seropositivity for acetylcholine receptors and titin antibodies (P<0.001). In very late-onset MG, a lower proportion of patients retained minimal manifestations status or better, a higher proportion of patients had MG-related deaths (P<0.001), and a shorter maintenance time of minimal manifestation status or better was seen at the last follow-up (P=0.007) than that in patients with early- and late-onset MG. Non-immunotherapy may associated with a poor prognosis in patients in the very late-onset group. Further studies on very late-onset MG patients should be performed to evaluate the relationship between immunotherapy and prognosis.
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Affiliation(s)
- Yong-Lan Tang
- 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.
| | - Yue Su
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - 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
| | - Yu Liu
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, 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
| | - 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.
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11
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Liu YD, Tang F, Li XL, Liu YF, Zhang P, Yang CL, Du T, Li H, Wang CC, Liu Y, Yang B, Duan RS. Type 2 diabetes mellitus as a possible risk factor for myasthenia gravis: a case-control study. Front Neurol 2023; 14:1125842. [PMID: 37139075 PMCID: PMC10149973 DOI: 10.3389/fneur.2023.1125842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background A certain number of myasthenia gravis (MG) patients clinically had type 2 diabetes mellitus (T2DM) prior to MG onset, which suggests that the onset of MG may correlate with the history of T2DM. This study aimed to examine the correlation between MG and T2DM. Methods In a single-center, retrospective, 1:5 matched case-control study, all 118 hospitalized patients with a diagnosis of MG from 8 August 2014 to 22 January 2019 were enrolled. In total, four datasets with different sources of the control group were retrieved from the electronic medical records (EMRs). Data were collected at the individual level. A conditional logistic regression analysis was used to test the risk of MG associated with T2DM. Findings The risk of MG was significantly associated with T2DM, and there were notable differences by sex and age. Whether compared to the general population, general hospitalized patients without autoimmune diseases (AIDs), or patients with other AIDs except MG, women aged over 50 years with T2DM had an increased risk of MG. The mean onset age of diabetic MG patients was more than that of the non-diabetic MG patients. Interpretation This study demonstrates that T2DM is strongly associated with the subsequent risk of MG and varies significantly by sex and age. It reveals that diabetic MG may be a unique subtype that is different from the conventional MG subgroup classification. More clinical and immunological features of diabetic MG patients need to be explored in further studies.
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Affiliation(s)
- Yu-Dong Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Fang Tang
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Xiao-Li Li
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Ya-Fei Liu
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Peng Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Chun-Lin Yang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Tong Du
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Heng Li
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Cong-Cong Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Bing Yang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
| | - Rui-Sheng Duan
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Institute of Neuroimmunology, Jinan, China
- *Correspondence: Rui-Sheng Duan
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12
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Chen K, Li Y, Yang H. Poor responses and adverse outcomes of myasthenia gravis after thymectomy: Predicting factors and immunological implications. J Autoimmun 2022; 132:102895. [PMID: 36041292 DOI: 10.1016/j.jaut.2022.102895] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
Myasthenia gravis (MG) has been recognized as a series of heterogeneous but treatable autoimmune conditions. As one of the indispensable therapies, thymectomy can achieve favorable prognosis especially in early-onset generalized MG patients with seropositive acetylcholine receptor antibody. However, poor outcomes, including worsening or relapse of MG, postoperative myasthenic crisis and even post-thymectomy MG, are also observed in certain scenarios. The responses to thymectomy may be associated with the general characteristics of patients, disease conditions of MG, autoantibody profiles, native or ectopic thymic pathologies, surgical-related factors, pharmacotherapy and other adjuvant modalities, and the presence of comorbidities and complications. However, in addition to these variations among individuals, pathological remnants and the abnormal immunological milieu and responses potentially represent major mechanisms that underlie the detrimental neurological outcomes after thymectomy. We underscore these plausible risk factors and discuss the immunological implications therein, which may be conducive to better managing the indications for thymectomy, to avoiding modifiable risk factors of poor responses and adverse outcomes, and to developing post-thymectomy preventive and therapeutic strategies for MG.
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Affiliation(s)
- Kangzhi Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
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13
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Zhao S, Yan X, Ding J, Ren K, Sun S, Lu J, Zhang C, Zhang K, Li Z, Guo J. Lack of Immunotherapy as the Only Predictor of Secondary Generalization in Very-Late-Onset Myasthenia Gravis With Pure Ocular Onset. Front Neurol 2022; 13:857402. [PMID: 35547386 PMCID: PMC9081806 DOI: 10.3389/fneur.2022.857402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
During the past two decades, an increasing number of patients with very-late-onset myasthenia gravis (v-LOMG) with an onset age of 65 years or older have been identified. However, few studies explore the predictors of secondary generalization in patients with v-LOMG with pure ocular onset. In this retrospective cohort study, 69 patients with v-LOMG were divided into ocular MG (OMG) and generalized MG (GMG), and the clinical characteristics and outcomes were compared. Cox regression analysis was performed to explore the predictors of generalization. The average onset age of the study population was 73.1 ± 4.2 years and the median disease duration was 48.0 months (interquartile range, 32.5-64.5 months). Serum acetylcholine receptor (AChR) antibody was detected in up to 86% of patients and concomitant diseases in approximately half of the patients. Male predominance was seen in OMG group while female predominance in GMG group (p = 0.043). Patients with OMG showed a lower positive rate of repetitive nerve stimulation (RNS) than those with GMG (p = 0.014), and favorable outcomes were obtained in more patients with OMG than those with GMG (p < 0.001). Of the 51 patients with pure ocular onset, 25 (49.0%) underwent secondary generalization. A higher probability of generalization was found in patients with positive RNS results and without immunotherapy (p = 0.018 and <0.001). Upon Cox regression analysis, immunotherapy was negatively associated with secondary generalization [HR (hazard ratio) 0.077, 95%CI [0.024-0.247], p < 0.001]. Altogether, compared to the patients with very-late-onset GMG, the counterparts with OMG exhibit a significantly higher female predominance and a lower positive rate of RNS tests, especially on facial and accessory nerves. Lack of immunotherapy is the only predictor of secondary generalization in those with pure ocular onset.
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Affiliation(s)
- Sijia Zhao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xu Yan
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
- Department of Neurology, Suide County Hospital, Yulin, China
| | - Jiaqi Ding
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Kaixi Ren
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Shuyu Sun
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jiarui Lu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chao Zhang
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Kai Zhang
- Department of Intensive Care Unit, Xi'an, Hospital, Xi'an, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
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14
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Permanasari A, Tinduh D, Wardhani IL, Subadi I, Sugianto P, Prawitri YD. Correlation between Fatigue and Ability to Perform Activities of Daily Living in Myasthenia Gravis Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Myasthenia Gravis (MG) is an autoimmune disease of the neuromuscular junction that has autoantibodies that can be found in most cases. Fatigue and skeletal muscle weakness are the pathognomonic symptoms of MG and can be severely disabling, interfering with a patient’s ability to pursue activities of daily living, limiting their work, family, and social lives.
AIM: This study aimed to analyze the correlation between fatigue and the ability to perform activity of daily living (ADL) among patients with MG.
METHOD: Fatigue severity scale (FSS) was used to measure the fatigue and MG-ADL scale was used to evaluate the patient’s ability to perform ADL. Rank-Spearman test was used to assess the correlation between fatigue and patient’s ability to perform daily activities.
RESULTS: Thirty-one patients (nine males and 22 females) with MG were included and classified into three subgroups of fatigue: Non-fatigue (FSS <4), borderline (4 < FSS < 5), and fatigue (FSS >5). There was a significant correlation between fatigue and the patient’s ability to perform ADL (p = 0.005; p = 0.488) with CI 95%.
CONCLUSION: Fatigue in patients with MG correlates with the ability to perform ADL.
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15
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Li Y, Dong X, Li Z, Peng Y, Jin W, Zhou R, Jiang F, Xu L, Luo Z, Yang H. Characteristics of myasthenia gravis in elderly patients: a retrospective study. Neurol Sci 2021; 43:2775-2783. [PMID: 34677704 DOI: 10.1007/s10072-021-05599-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of myasthenia gravis (MG) is increasing, and its characteristics in elderly patients are believed to differ from those in younger patients. However, only a few studies have focused on elderly patients with MG. OBJECTIVE To review the characteristics of MG in elderly patients and evaluate whether older age is an independent factor associated with achieving minimal manifestation status (MMS). METHODS This retrospective cohort study included 367 patients (319 non-elderly and 48 elderly patients) with MG enrolled at Xiangya Hospital from September 1, 2016, to December 31, 2018. We collected demographic data and information regarding comorbidities, antibody status, Myasthenia Gravis Foundation of America classification, affected muscle groups, thymoma, and treatment. MMS was defined as the primary outcome. RESULTS Comorbidities were more common in elderly than in younger patients with MG. Anti-acetylcholine receptor antibody was the dominant subtype, whereas anti-muscle-specific tyrosine kinase antibody was rare and detected only in non-elderly patients. Elderly patients were more likely than younger patients to have generalized MG, but the frequency of thymoma was lower (28.5% vs. 10.4%, p = 0.0078). MMS or better was achieved in 154 (48.3%) and 13 (27.1%) non-elderly and elderly patients, respectively. Older age did not appear to be an independent factor associated with MMS (hazard ratio = 0.625; 95% confidence interval, 0.345-1.131). CONCLUSIONS Older age was not an independent factor for a worse prognosis in patients with MG. The treatment of elderly patients with MG should be individually tailored.
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Affiliation(s)
- Yi Li
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Xiaohua Dong
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Zhibin Li
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Yuyao Peng
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Wanlin Jin
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Ran Zhou
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Liqun Xu
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Zhaohui Luo
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410000, People's Republic of China.
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Belimezi M, Kalliaropoulos A, Jiménez J, Garcia I, Mentis AFA, Chrousos GP. Age at sampling and sex distribution of AChRAb vs. MuSKAb myasthenia gravis in a large Greek population. Clin Neurol Neurosurg 2021; 208:106847. [PMID: 34343914 DOI: 10.1016/j.clineuro.2021.106847] [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: 04/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Myasthenia gravis (MG) is a typical B-cell-mediated neuromuscular junction disease that can be classified into seropositive and seronegative subtypes. Association of patients' age at sampling and sex with the two major seropositive MG subcategories, i.e., MGs linked to antibodies directed against the acetylcholine receptor (AChRAb) and against the muscle-specific kinase (MuSKAb), has not been compared in a large population. METHODS We performed a retrospective analysis of samples from patients with MG in Greece who underwent neurochemical diagnostic evaluation between January 2, 2013, and August 31, 2016. RESULTS Overall, 1620 adult (623 male and 997 female patients; male-to-female ratio = 0.62) and 51 pediatric patients were found to be seropositive for MG. The distributions in both male and female patients were bimodal in the total and AChRAb MG cases but not in the total MuSKAb MG cases. Significant differences in the age at sampling distribution between the male and female adult patients were observed only in the AChRAb MG subtype. Significant differences between the AChRAb and MuSKAb MG categories were noted in the mean age values (60.10 and 51.49 years, respectively, for female and 65.69 and 56.19 years, respectively, for male adult patients). CONCLUSION Our findings confirm an uneven profile of age at sampling and sex between the AChRAb and MuSKAb MG cases in a large population. Future mechanistic studies can elucidate the cause of these differences. Moreover, clinical studies can explore how such differences can affect MG treatment and prognosis.
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Affiliation(s)
- Maria Belimezi
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece
| | | | - Juan Jiménez
- ADEMA Universitary School, University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
| | - Irene Garcia
- Department of Mathematical Sciences and Informatics, and Health Research Institute (IdISBa), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
| | - Alexios-Fotios A Mentis
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece; University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias, Athens, Greece.
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias, Athens, Greece
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Wang L, Wang S, Yang H, Han J, Zhao X, Han S, Zhang Y, Lv J, Zhang J, Li M, Ji Y, Zhou S, He X, Fang H, Yang J, Zhang Y, Zhang Q, Gao P, Gao F. No correlation between acetylcholine receptor antibody concentration and individual clinical symptoms of myasthenia gravis: A systematic retrospective study involving 67 patients. Brain Behav 2021; 11:e02203. [PMID: 34075720 PMCID: PMC8323040 DOI: 10.1002/brb3.2203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the correlation between acetylcholine receptor antibodies (AChR-Ab) concentration levels and individualized clinical symptoms in patients with AChR myasthenia gravis (AChR-MG) in China. METHODS ELISA was used to determine the concentration of AChR-Ab in patients with MG. The Myasthenia Gravis Foundation of America (MGFA) Clinical Classification, Quantitative Myasthenia Gravis (QMG) score, and MG-specific activities of daily living (MG-ADL) scoring systems were used to evaluate the clinical status of patients. Spearman correlation analysis was used to determine the correlation between the AChR-Ab concentration and clinical score. The changes in the antibody concentration and clinical score are shown in MGFA-antibody concentration-treatment plots. RESULTS Autoantibody detection tests were performed in 67 patients, and their clinical scores were recorded. Forty-nine patients received immunosuppressive therapy, 17 patients received pyridostigmine only, and 1 patient under thymectomy without any medication. The AChR-Ab concentration correlated with the MGFA Classification in 5 (29.4%) patients in the pyridostigmine-only group and 15 (30.6%) patients in the immunosuppressive drug group. The changes in the MGFA Classification preceded the changes in the AChR-Ab concentration in 4 (23.5%) patients treated with pyridostigmine and 10 (20.4%) patients on immunosuppressive drugs. In patients on oral non-steroidal immunosuppressants, the AChR-Ab concentration changed by more than 50%, whereas the MGFA Classification did not increase. The AChR-Ab concentration decreased in 17/32 (53.1%) patients after thymectomy, and then increased, whereas the AChR-Ab concentration increased in 15/32 (46.9%) patients and the MGFA Classification decreased in 27/32 (81.8%) patients after thymectomy. The AChR-Ab concentration presented a slight correlation with the corresponding MGFA, QMG, and MG-ADL in patients with thymoma. DISCUSSION In the Chinese AChR-MG population, the Changes in the AChR-Ab concentration in individuals with AChR-MG did not consistently correlate with the severity of clinical symptoms.
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Affiliation(s)
- Lulu Wang
- Department of NeurologyThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Shumin Wang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- Basic Medical CollegeZhengzhou UniversityZhengzhouChina
| | - Haonan Yang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- BGI CollegeZhengzhou UniversityZhengzhouChina
| | - Jiaojiao Han
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- Basic Medical CollegeZhengzhou UniversityZhengzhouChina
| | - Xue Zhao
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Sensen Han
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- BGI CollegeZhengzhou UniversityZhengzhouChina
| | - Yingna Zhang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Jie Lv
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Jing Zhang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Mingqiang Li
- Department of NeurologyThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Ying Ji
- Department of NeurologyThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Shuxian Zhou
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- Basic Medical CollegeZhengzhou UniversityZhengzhouChina
| | - Xiaoxiao He
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
- BGI CollegeZhengzhou UniversityZhengzhouChina
| | - Hua Fang
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
| | - Junhong Yang
- Department of EncephalopathyFirst Affiliated Hospital of Henan University of TCMZhengzhouChina
| | - Yunke Zhang
- Department of EncephalopathyFirst Affiliated Hospital of Henan University of TCMZhengzhouChina
| | - Qingyong Zhang
- Myasthenia Gravis Comprehensive Diagnosis and Treatment CenterHenan Provincial People’s HospitalZhengzhouChina
| | - Peiyang Gao
- Department of Clinical MedicineXinxiang Medical University Sanquan Medical CollegeXinxiangChina
| | - Feng Gao
- Department of Neuroimmunology, Henan Institute of Medical and Pharmaceutical SciencesZhengzhou UniversityZhengzhouChina
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Ke B, Zhang T, An T, Lu R. Soy isoflavones ameliorate the cognitive dysfunction of Goto-Kakizaki rats by activating the Nrf2-HO-1 signalling pathway. Aging (Albany NY) 2020; 12:21344-21354. [PMID: 33180745 PMCID: PMC7695387 DOI: 10.18632/aging.103877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Soy isoflavones (SIF) are soybean phytochemicals that are considered to be biologically active components that protect from neurodegenerative diseases. In this study, the therapeutic effect of SIF was evaluated in a diabetic Goto-Kakizaki (GK) rat model. Twenty male GK rats were randomly divided into diabetes mellitus (DM) model group and SIF+DM group (n=10 in each group). Twenty age-matched male Wistar rats were randomly divided into control group (CON group) and CON+SIF group, with 10 rats in each group. The learning and memory functions of the animals were determined by the Morris water maze (MWM) test. Hematoxylin-eosin staining (HE) was performed to examine pyramidal neuron loss in the CA1 area of the hippocampus. Markers of oxidative stress (OS) were measured to evaluate oxidative stress-mediated injury. RT-PCR and western blotting were used to analyze the expression of nuclear factorerythroid2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1) and NAD(P)H dehydrogenase quinone1 (NQO1). Treatment with SIF for 4 weeks alleviated the cognitive dysfunction of the GK rats as determined by the MWM test. Moreover, SIF treatment also reduced diabetes-related oxidative reactions. In addition, SIF enhanced the expression of Nrf2, HO-1 and NQO1, suggesting a potential antioxidation mechanism for the effect of SIF. These findings suggest that SIF can be considered candidates for inhibiting the progression of diabetes-induced cognitive dysfunction, provide novel insights into the antioxidant effect of SIF and further strengthen the link between oxidative stress and diabetes.
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Affiliation(s)
- Boxi Ke
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang Province, PR China
| | - Tianmeng Zhang
- Jitang College of North China University of Science and Technology, Tangshan, Hebei Province, PR China
| | - Tianyang An
- Jitang College of North China University of Science and Technology, Tangshan, Hebei Province, PR China
| | - Rong Lu
- Anesthesiology Department, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang Province, PR China
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Oliveira R, Landeiro L, Lauterbach M. Very late onset of myasthenia gravis: case report and brief review of the literature. Acta Neurol Belg 2020; 120:981-982. [PMID: 32052362 DOI: 10.1007/s13760-020-01290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
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20
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Lotan I, Benninger F, Hellmann MA, Sicsic C, Brenner T, Kahana E, Steiner I. Incidence of AChR Ab-positive myasthenia gravis in Israel: A population-based study. Acta Neurol Scand 2020; 142:66-73. [PMID: 32145067 DOI: 10.1111/ane.13239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of myasthenia gravis (MG) has traditionally been low, ranging between 2-6/106 . Several recent epidemiological studies have reported a higher incidence. We, therefore, aimed to assess and characterize the incidence of MG in Israel. METHODS We retrospectively reviewed the records of all four laboratories that performed the acetylcholine receptor antibody (AChR Ab) test in Israel between 1994 and 2013 and documented the number of newly diagnosed seropositive MG patients each year. To assure that data indeed reflect only newly diagnosed patients, patient's names and ID numbers were screened at the Hadassah medical center database since 1978, the year when the test was first performed in Israel. In order to calculate the annual incidence of the disease, the population at risk was derived from the annual publication of the Israeli Central Bureau of Statistics. RESULTS The annual incidence of MG for this time period was 13.1/106 inhabitants. The mean incidence of MG between 1994 and 2003 was 7.695/106 /y, while the mean incidence between 2004 and 2013 was 18.49/106 (P < .0001). Mean age of diagnosis between 1994 and 2003 was 56.65 ± 0.9351, while between 2004 and 2013, it was 59.89 ± 0.5336 (P = .0012). Male to female (M:F) incidence ratio in the years 1994-2003 and 2004-2013 was 2:3.2 and 3:1.8, respectively, reflecting increased incidence among males (P < .0001). CONCLUSIONS The incidence of MG in Israel has increased significantly during the last decade, especially among males of older age. These findings may reflect an etiological role of an environmental factor, increased awareness, and increased longevity in general.
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Affiliation(s)
- Itay Lotan
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Felix Benninger
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mark A. Hellmann
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Camille Sicsic
- Laboratory of Neuroimmunology Department of Neurology The Agnes –Ginges Center for Neurogenetics Hebrew University Hadassah Medical Center Jerusalem Israel
| | - Talma Brenner
- Laboratory of Neuroimmunology Department of Neurology The Agnes –Ginges Center for Neurogenetics Hebrew University Hadassah Medical Center Jerusalem Israel
| | - Ester Kahana
- Department of Neurology Barzilai Medical Center Ashkelon Israel
- Faculty of Health Sciences Ben‐Gurion University of the Negev Beer Sheva Israel
| | - Israel Steiner
- Department of Neurology Rabin Medical Center Beilinson Campus Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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21
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Ding J, Zhao S, Ren K, Dang D, Li H, Wu F, Zhang M, Li Z, Guo J. Prediction of generalization of ocular myasthenia gravis under immunosuppressive therapy in Northwest China. BMC Neurol 2020; 20:238. [PMID: 32527235 PMCID: PMC7288410 DOI: 10.1186/s12883-020-01805-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well demonstrated that immunosuppressants can reduce, but not eliminate the risk of generalized development in ocular myasthenia gravis (OMG). In this study, we aimed to explore the predictive factors of generalized conversion of OMG patients who received immunosuppressive treatments. METHODS OMG patients under immunosuppressive treatments in Tangdu Hospital from June 2008 to June 2012 were retrospectively reviewed. Baseline clinical characteristics were documented. Patients were followed up regularly by face-to-face interview and the main outcome measure was generalized conversion. The logistic regression analysis was performed to determine the predictive factors of generalization of OMG. RESULTS Two hundred twenty-three eligible OMG patients completed the final follow-up visit and 38 (17.0%) progressed to generalized MG (GMG) at a median time to generalization of 0.9 year. Patients with adult onset and positive repetitive nerve stimulation (RNS) of facial or axillary nerve had higher conversion rate than those with juvenile onset and negative RNS (p = 0.001; p = 0.019; p = 0.015, respectively). Adult-onset patients converted earlier than juvenile-onset OMG patients (p = 0.014). Upon multivariate logistic regression analysis, age of onset (Odds ratio [OR] 1.023, 95% confidence interval [CI] 1.006-1.041, p = 0.007) and positive facial nerve RNS (OR 2.826, 95%CI 1.045-5.460, p = 0.038) were found to be positively associated with generalized development. Moreover, an obviously negative association was found for disease duration (OR 0.603, 95%CI 0.365-0.850, p = 0.019). CONCLUSIONS Age of onset, disease duration and facial nerve RNS test can predict generalized conversion of OMG under immunosuppressive therapy. Adult-onset, shorter disease duration and facial nerve RNS-positive OMG patients have a higher risk of generalized development.
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Affiliation(s)
- Jiaqi Ding
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Sijia Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Kaixi Ren
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Dan Dang
- Intensive Care Unit, Xi'an Fourth Hospital, Xi'an, 710004, Shaanxi Province, China
| | - Hongzeng Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Fang Wu
- Department of Neurology, Xi'an Children's Hospital, Xi'an, 710003, Shaanxi Province, China
| | - Min Zhang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi Province, China.
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22
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Angelopoulou E, Paudel YN, Piperi C. Unraveling the Role of Receptor for Advanced Glycation End Products (RAGE) and Its Ligands in Myasthenia Gravis. ACS Chem Neurosci 2020; 11:663-673. [PMID: 32017530 DOI: 10.1021/acschemneuro.9b00678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune T cell-dependent B cell-mediated disorder of the neuromuscular junction (NMJ) characterized by fluctuating skeletal muscle weakness, most commonly attributed to pathogenic autoantibodies against postsynaptic nicotinic acetylcholine receptors (AChRs). Although MG pathogenesis is well-documented, there are no objective biomarkers that could effectively correlate with disease severity or MG clinical subtypes, and current treatment approaches are often ineffective. The receptor for advanced glycation end products (RAGE) is a multiligand cell-bound receptor highly implicated in proinflammatory responses and autoimmunity. Preclinical evidence demonstrates that RAGE and its ligand S100B are upregulated in rat models of experimental autoimmune myasthenia gravis (EAMG). S100B-mediated RAGE activation has been shown to exacerbate EAMG, by enhancing T cell proinflammatory responses, aggravating T helper (Th) subset imbalance, increasing AChR-specific T cell proliferative capacity, and promoting the production of antibodies against AChRs from the spleen. Soluble sRAGE and esRAGE, acting as decoys of RAGE ligands, are found to be significantly reduced in MG patients. Moreover, MG has been associated with increased serum levels of S100A12, S100B and HMGB1. Several studies have shown that the presence of thymic abnormalities, the onset age of MG, and the duration of the disease may affect the levels of these proteins in MG patients. Herein, we discuss the emerging role of RAGE and its ligands in MG immunopathogenesis, their clinical significance as promising biomarkers, as well as the potential therapeutic implications of targeting RAGE signaling in MG treatment.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Yam Nath Paudel
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, 46150 Selangor, Malaysia
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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23
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Associations of BAFF rs2893321 polymorphisms with myasthenia gravis susceptibility. BMC MEDICAL GENETICS 2019; 20:168. [PMID: 31666013 PMCID: PMC6822419 DOI: 10.1186/s12881-019-0906-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022]
Abstract
Background Myasthenia gravis (MG) is an autoimmune diseases characterized by fatigue and weakness of skeletal muscles. B-lymphocyte-activating factor (BAFF), an essential factor for B cell differentiation and development, is important in the progression of MG. The current study aimed to investigate the association between single nucleotide polymorphism rs2893321 in BAFF with MG susceptibility in Chinese Han population. Methods One hundred forty-nine patients with MG and 148 healthy controls were recruited. Using improved multiple ligase detection reaction technology, the polymorphisms of rs2893321 between groups and among MG subgroups have been compared. Results A significant differences between the MG group and the healthy control group was observed. Additionally, rs2893321 was found to be associated with gender and age in patients with MG. Conclusion Genetic variations of rs2893321 in BAFF might be associated with susceptibility to MG in the Chinese Han population.
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Li M, Ge F, Guo R, Ruan Z, Gao Y, niu C, Lin H, Zhao Z, Zhou Y, Li Z, Chang T. Do early prednisolone and other immunosuppressant therapies prevent generalization in ocular myasthenia gravis in Western populations: a systematic review and meta-analysis. Ther Adv Neurol Disord 2019; 12:1756286419876521. [PMID: 35173803 PMCID: PMC8842340 DOI: 10.1177/1756286419876521] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/25/2019] [Indexed: 01/19/2023] Open
Abstract
Background: The majority of ocular myasthenia gravis (OMG) patients will progress to
generalized myasthenia gravis (GMG), usually within 2 years of disease
onset. The aim of this meta-analysis was to evaluate the effect of early
prednisolone and other immunosuppressants therapy on the generalization rate
in OMG patients. Methods: We searched the CENTRAL, EMBASE, and MEDLINE databases via
the Ovid SP database for all relevant publications on 16 July 2018. Results: Eight studies comprising a total of 547 participants were included in our
meta-analysis. Compared with pyridostigmine treatment, prednisolone and
other immunosuppressants therapy produced an odds ratio (OR) for the
development of GMG of 0.19 [95% confidence interval (CI), 0.11–0.30;
I2 = 37%], indicating that early
prednisolone and other immunosuppressants therapy reduced the generalization
rate in OMG by 81%. Conclusions: Early prednisolone and other immunosuppressants therapy can significantly
reduce the risk of generalization in OMG patients, and should be considered
in newly diagnosed OMG patients. Due to the inclusion of retrospective
studies, this noted effect might have been related to corticosteroids,
especially when immunosuppressants used at low dosages and in mild disease.
Additionally, the data derived from Western populations, thus a prospective
randomized controlled trial (RCT) is warranted to confirm this effect of
early prednisolone and other immunosuppressants therapy on OMG
generalization both in Western and Asian populations.
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Affiliation(s)
- Mingxia Li
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Fangfang Ge
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Rongjing Guo
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Yanwu Gao
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Chunxiao niu
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Hong Lin
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Zhengwei Zhao
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Yongan Zhou
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shaanxi Province, P.R. China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi Province, P.R. China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi Province, P.R. China
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