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Miyaguchi R, Masuda F, Sumi Y, Kadotani H, Ozeki Y, Banno M, Kuniyoshi Y. Prevalence of depression or depressive state in patients with restless legs syndrome: A systematic review and meta-analysis. Sleep Med Rev 2024; 77:101975. [PMID: 39024776 DOI: 10.1016/j.smrv.2024.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
Restless legs syndrome (RLS) is a common sleep-related disorder characterized by limb discomfort and the urge to move them when at rest, especially in the evening or at night. Although depression is often linked to various conditions, no systematic review has assessed depression prevalence in patients with RLS after the latest diagnostic criteria revision. This systematic review and meta-analysis aimed to investigate the depression and depressive state prevalence among patients with RLS. We systematically searched databases up to November 2022 and performed meta-analyses of the depression prevalence using a random-effects model and a meta-regression analysis to explore the relationship between the prevalence and severity of depression and factors such as age and RLS severity. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed 24 studies with 2039 patients. The pooled depression or depressive state prevalence, mostly defined by questionnaire scores, was 30.39 %. Nine studies reported the proportion of patients taking antidepressants (pooled rate: 3.41 %). No specific factors related to the prevalence or severity of depression were identified in patients with RLS. These findings highlight the significant prevalence of depression and underscore the need for future research with standardized diagnostic interviews and consistent methodologies across multi-site studies.
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Affiliation(s)
- Rin Miyaguchi
- Faculty of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Fumi Masuda
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan; Department of Psychiatry, Nagahama Red Cross Hospital, Shiga, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan.
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Masahiro Banno
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan
| | - Yasutaka Kuniyoshi
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Aomori, Japan
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Uzawa A, Suzuki S, Kuwabara S, Akamine H, Onishi Y, Yasuda M, Ozawa Y, Kawaguchi N, Kubota T, Takahashi MP, Suzuki Y, Watanabe G, Kimura T, Sugimoto T, Samukawa M, Minami N, Masuda M, Konno S, Nagane Y, Utsugisawa K. Effectiveness of early cycles of fast-acting treatment in generalised myasthenia gravis. J Neurol Neurosurg Psychiatry 2023; 94:467-473. [PMID: 36693723 DOI: 10.1136/jnnp-2022-330519] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Early fast-acting treatment (EFT) is the aggressive use of fast-acting therapies such as plasmapheresis, intravenous immunoglobulin and/or intravenous high-dose methylprednisolone (IVMP) from the early phases of treatment. EFT is reportedly beneficial for early achievement of minimal manifestations (MM) or better status with ≤5 mg/day prednisolone (MM5mg), a practical therapeutic target for myasthenia gravis (MG). OBJECTIVE The current study aimed to clarify which specific EFT regimen is efficacious and the patient characteristics that confer sensitivity to EFT. METHODS We recruited a total of 1710 consecutive patients with MG who enrolled in the Japan MG Registry for this large-cohort study. Among them, 1066 with generalised MG who had received immunotherapy were analysed. Prognostic background factors were matched in a 1:1 ratio using propensity score matching analysis between patients treated with EFT (n=350) and those treated without EFT (n=350). The clinical course and time to first achieve MM5mg after starting immunotherapy was analysed in relation to treatment combinations and patient characteristics. RESULTS Kaplan-Meier analyses showed that EFT had a significant effect on the achievement of MM5mg (p<0.0001, log-rank test; HR 1.82, p<0.0001). Notably, EFT was efficacious for any type of MG, and the inclusion of IVMP resulted in earlier and more frequent achievement of MM5mg (p=0.0352, log-rank test; HR 1.46, p=0.0380). In addition, early administration of calcineurin inhibitors also promoted MM5mg achievement. CONCLUSION Early cycles of intervention with EFT and early use of calcineurin inhibitors provides long-term benefits in terms of achieving therapeutic targets for generalised MG, regardless of clinical subtype.
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Affiliation(s)
- Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Akamine
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yosuke Onishi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Manato Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukiko Ozawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Kawaguchi
- Department of Neurology, Neurology Chiba Clinic, Chiba, Japan
| | - Tomoya Kubota
- Department of Clinical Laboratory and Biomedical Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masanori P Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Suzuki
- Department of Neurology, National Hospital Organisation Sendai Medical Center, Sendai, Miyagi, Japan
| | - Genya Watanabe
- Department of Neurology, National Hospital Organisation Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Kimura
- Department of Neurology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Takamichi Sugimoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Makoto Samukawa
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Naoya Minami
- Department of Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Masayuki Masuda
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Shingo Konno
- Department of Neurology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
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Mental health in myasthenia gravis patients and its impact on caregiver burden. Sci Rep 2022; 12:19275. [PMID: 36369246 PMCID: PMC9652470 DOI: 10.1038/s41598-022-22078-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric comorbidities are relevant in patients with Myasthenia gravis (MG). Also, MG patients experience a reduced health-related quality of life (HRQoL). We aimed to quantify the impact of depression as well as self-perceived MG severity on HRQoL and caregivers' burden. In this cross-sectional study, we used a survey encompassing demographic, disease-related information, and standardized questionnaires to assess symptoms of depression, anxiety, HRQoL (MG Quality of Life scale; MG-QoL15), and caregiver burden (Burden Scale for Family Caregivers; BSFC). Data from 1399 participating patients (96%) and 1042 caregivers (65%) were eligible for further analysis. Symptoms of depression and anxiety disorder were indicated by 31% and 36% of patients. Self-reported MG severity (MG severity) and MG-QoL15 scores were strongly associated (estimated marginal means for severe versus mild MG severity = 18 95% CI [16; 21]; p ≤ 0.001). Adjusting for symptoms of depression decreased the estimated strength of this association (estimated marginal means for severe versus mild MG severity = 15 [13; 17]; p ≤ 0.001). Caregiver burden was associated to MG disease severity (estimated marginal means for severe vs. mild MG severity = 0.16 [0.13; 0,19); p ≤ 0.001) and also negatively influenced by symptoms of depression (estimated marginal means = 0.12 [0.09; 0.15]). Symptoms of depression and anxiety disorder in MG are frequent. Beyond MG severity, symptoms of depression have negative effects on HRQoL as well as on caregivers' burden. Diagnosis and treatment of psychiatric comorbidities should be considered an important element in MG care. Screening tools for mental health conditions should be implemented at least in specialized MG centers.
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Kim KH, Kim SW, Cho J, Chung HY, Shin HY. Anti-titin antibody is associated with more frequent hospitalization to manage thymoma-associated myasthenia gravis. Front Neurol 2022; 13:978997. [PMID: 36277908 PMCID: PMC9581133 DOI: 10.3389/fneur.2022.978997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Anti-titin antibodies are antistriational antibodies associated with thymoma-associated myasthenia gravis (MG). We evaluated whether the patients with anti-titin antibody are more frequently hospitalized to manage thymoma-associated MG than those patients without anti-titin antibody. METHODS Patients with thymoma-associated MG who conducted the serological test for anti-titin antibody were retrospectively included. Disease severity, treatments, MG-related annual hospitalization rate, and MG-related emergency room (ER) visit rate were compared between the patients with anti-titin antibody and those patients without anti-titin antibody. Multivariate analysis was conducted to analyze the association between anti-titin antibody serostatus and multiple admissions (hospitalization or ER visit of ≥2 times). RESULTS Of the 64 included patients, 31 (48.4%) patients were positive for anti-titin antibody (titin+ group) and 33 (51.6%) patients were negative for anti-titin antibody (titin- group). Both the annual rate of MG-related hospitalization and ER visit were significantly higher in the titin+ group [0.2 (0.1-0.6) and 0.1 (0-0.2) per year, respectively] than those in the titin- group [0 (0-0.2) and 0 (0-0) per year, p = 0.004 and p = 0.006, respectively]. In multivariate analysis, positive anti-titin antibody was still significantly associated with multiple admissions [odds ratio (OR) 4.11, 95% CI 1.05-16.03] compared to the titin- group as a reference after adjusting for sex, follow-up duration, age at onset, systemic chemotherapy, and the Masaoka staging. CONCLUSION The presence of anti-titin antibody is associated with more frequent hospital utilization. Personalized explanation and careful monitoring strategy could be required in patients with thymoma-associated MG with anti-titin antibody for the timely detection of relapses.
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Affiliation(s)
- Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Seung Woo Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jinhyuk Cho
- Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Yoon Chung
- Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Young Shin
- Yonsei University College of Medicine, Seoul, South Korea
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Zhang Y, Li F, Zhu H, Yu H, Wang T, Yan X. Less is not necessarily more: low-dose corticosteroid therapy and long-term prognosis in generalized myasthenia gravis after thymectomy. Neurol Sci 2022; 43:3949-3956. [DOI: 10.1007/s10072-022-05897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
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Gilhus NE, Verschuuren JJGM, Hovland SIB, Simmonds H, Groot F, Palace J. Myasthenia gravis: do not forget the patient perspective. Neuromuscul Disord 2021; 31:S0960-8966(21)00583-6. [PMID: 34635387 DOI: 10.1016/j.nmd.2021.07.396] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway.
| | | | | | - Huw Simmonds
- Myaware, College Business Centre, Derby, England
| | - Floor Groot
- Dutch Neuromuscular disease Association, Baarn, The Netherlands
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Hospitals Trust, Oxford, England
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Yoshimoto Y, Ishida S, Hosokawa T, Arawaka S. Assessment of clinical factors affecting outcome of myasthenia gravis. Muscle Nerve 2021; 64:90-94. [PMID: 33885175 DOI: 10.1002/mus.27247] [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: 10/01/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION/AIMS In myasthenia gravis (MG) therapy, achieving Myasthenia Gravis Foundation of America minimal manifestation (MM) or better status is proposed as a desirable target. However, this level of control is often not achieved and clinical factors affecting prognosis remain unclear. METHODS Participants were 104 consecutive patients with MG who visited Osaka Medical College Hospital. We retrospectively assessed the association of clinical and laboratory features at baseline with prognosis. Eighty patients who achieved MM or better status were classified as the good outcome group and the remaining 24 patients were classified as the poor outcome group. RESULTS The rate of dysphagia at baseline was significantly higher in the poor outcome group than in the good outcome group (P = .002). The levels of serum total protein and albumin at baseline were both significantly lower in the poor outcome group than in the good outcome group (P = .036 and P = .014, respectively). In addition, Controlling Nutritional Status scores at baseline were significantly higher in the poor outcome group than in the good outcome group (P = .043). Multivariate analysis using a Cox proportional hazards model showed that dysphagia (hazard ratio [HR], 6.92; 95% confidence interval [CI], 1.49-40.31) and hypoalbuminemia (HR, 2.57; 95% CI, 1.04-6.57) at baseline were risk factors that predicted prognosis. DISCUSSION These findings suggest that dysphagia and hypoalbuminemia at baseline are associated with outcomes and are predictive risk factors for poorer outcomes in patients with MG.
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Affiliation(s)
- Yukiyo Yoshimoto
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Shimon Ishida
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Takafumi Hosokawa
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
| | - Shigeki Arawaka
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Osaka, Japan
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STATE ANXIETY ASSESSMENT IN PATIENTS WITH MYASTHENIA GRAVIS. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-2-76-48-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kreis OA, Alekseeva TM, Gavrilov YV, Valko PO, Valko Y. Diagnosis of sleepiness, fatigue and depression in patients with myasthenia gravis. ACTA ACUST UNITED AC 2020. [DOI: 10.17650/2222-8721-2020-10-4-27-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction. Examination of excessive daytime sleepiness, fatigue and depression in patients with myasthenia gravis is important for differential diagnosis of other disorders, and adds to a comprehensive clinical assessment.Objective. The aim is a comprehensive assessment of sleepiness, fatigue and depression and evaluation of the impact of autoimmune comorbidity on these symptoms in myasthenia gravis patients, using newly validated Russian versions of international questionnaires. The present article aims at familiarizing a wider Russian-speaking audience of specialists in the field of neuromuscular disease and sleep medicine with the main findings of our previously published work.Materials and methods. The study included 73 patients with MG and 230 control subjects. For sleepiness, fatigue and depression evaluation were used: Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS) (cognitive / physical / psychosocial subscales), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) (cognitive-affective and somatic domains), Spielberger–Khanin State Trait Anxiety Inventory (STAI).Results. The Fatigue Severity Scale and Fatigue Impact Scale showed good psychometric properties and can be used to identify distinct aspects of fatigue in patients with myasthenia gravis. The studied patient cohort revealed clinically significant fatigue (69.9 %), excessive daytime sleepiness (15.1 %), moderate to severe depression (20.5 %), a high level of personal (64.4 %) and situational anxiety (27.4 %). Among 13 patients with myasthenia gravis and additional autoimmune comorbidity, there were no significant differences in the severity of sleepiness, fatigue and depression compared with the main group.Conclusion. The use of self-reported scale of sleepiness, fatigue and depression combined with careful clinical-neurological characterization adds to a more comprehensive view of the patient. The identification of sleepiness, fatigue and depression can guide therapeutic decisions and contributes to a better patient care. The presence of concomitant autoimmune pathology in patients with myasthenia gravis does not seem to increase the severity of sleepiness, fatigue and depression.
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Affiliation(s)
- O. A. Kreis
- Almazov National Medical Research Centre, the Ministry of Health of Russia; North-Western State Medical University, the Ministry of Health of Russia
| | - T. M. Alekseeva
- Almazov National Medical Research Centre, the Ministry of Health of Russia
| | | | - P. O. Valko
- University Hospital Zurich, University of Zurich
| | - Yu. Valko
- University Hospital Zurich, University of Zurich
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Abstract
This study aimed to review studies focused on the affective comorbidities associated with myasthenia gravis and to determine the extent to which neuromuscular treatment modalities address non-somatic aspects of autoimmune myasthenia gravis. Depression, anxiety, and emotional hyperactivity can aggravate myasthenia gravis, hinder accurate diagnoses, and presumably influence overall health-related quality of life. Studies were identified using PubMed Medline and Web of Science to assess the effects of psychological factors on myasthenia gravis, encompassing 49 years of research worldwide. After analysis, approximately 6,060 patients from 32 studies worldwide between 1971 and 2020 were included. Standard-of-care approaches to diagnosis and treatment continue to under-appreciate the prevalence or impact of mood disorders in myasthenia gravis. The majority of studies evaluated demonstrated an association between myasthenia gravis and mood disorders. However, the initiative to detect and treat affective comorbidities probably remains suboptimal. Although treatments for the somatic effects of myasthenia gravis have evolved over the past century, the paradigm of clinical practice has yet to adequately address the management of psychological impacts on the disease. This review is hoped to raise the necessary awareness in this regard.
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Affiliation(s)
- Christina Law
- Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Claire V Flaherty
- Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Prospective study of stress, depression and personality in myasthenia gravis relapses. BMC Neurol 2020; 20:261. [PMID: 32600271 PMCID: PMC7322879 DOI: 10.1186/s12883-020-01802-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Psychopathology and personality traits may influence the course of autoimmune disorders. With this prospective longitudinal cohort study, we aimed to assess personality, stress and depression in myasthenia patients who relapse and those who remain stable or improve (non-relapsers). Method We collected data from 155 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic, Toronto General Hospital, between March 2017 and July 2018, for this study. Patients were assessed at baseline and 6 months, or at the time of MG relapse. At both visits, the patients were assessed clinically and were asked to complete self-administered questionnaires for disease severity, chronic stress and depression. Personality type was assessed at baseline only. Relapsing patients were defined as those patients with MGII score increasing by more than 5.5 points from visit 1 to visit 2. Results Relapsers had higher baseline scores for depression (p = 0.01) and the change in disease severity correlated with the change in depression score (r = 0.2534, p = 0.0015, 95% CI: 0.098 0.3961). Higher levels of stress at baseline and neuroticism predicted higher relapse rates (p = 0.01 and p < .0001, respectively). In the linear regression model, with change of the MGII score as the dependent variable, change in depression scores (p = 0.0004) and age (p = 0.03) predicted change in disease severity. Conclusions Since emotional factors and personality type may influence MG, attention to these factors might improve care in MG patients.
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Affiliation(s)
- Anca Bogdan
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 5EC, Room 309 200 Elizabeth St, Toronto, ON, M5G 2G4, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 5EC, Room 309 200 Elizabeth St, Toronto, ON, M5G 2G4, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Abdulrahman Ali
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Alon Abraham
- Neuromuscular Diseases Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shabber Mannan
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 5EC, Room 309 200 Elizabeth St, Toronto, ON, M5G 2G4, Canada
| | - Eduardo Ng
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 5EC, Room 309 200 Elizabeth St, Toronto, ON, M5G 2G4, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, 5EC, Room 309 200 Elizabeth St, Toronto, ON, M5G 2G4, Canada. .,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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Gavrilov YV, Alekseeva TM, Kreis OA, Valko PO, Weber KP, Valko Y. Depression in myasthenia gravis: a heterogeneous and intriguing entity. J Neurol 2020; 267:1802-1811. [PMID: 32140868 DOI: 10.1007/s00415-020-09767-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depressive symptoms in myasthenia gravis (MG) are common, may mimic other disease features, and contribute to misdiagnosis and diagnostic delay. Nevertheless, the clinical determinants of depressive symptoms in MG remain poorly studied, in particular their overlap with fatigue. Moreover, studies in MG have rarely looked at distinct depression phenotypes. METHODS In 68 consecutive MG patients, we ascertained cognitive-affective and somatic depression with the Beck Depression Inventory (BDI), and also assessed age at disease onset, education, marital state, work ability, sleepiness, fatigue, and treatment modalities. Disease severity was graded according to the Myasthenia Gravis Foundation of America (MGFA) classification. RESULTS The prevalence of moderate-severe depression was 20.5%. While depression and fatigue showed large overlap (n = 37, 54.4%), only fatigue increased with disease severity, while BDI scores did not. Thymectomy was independently associated with lower BDI scores, but had no impact on fatigue. Total BDI scores were similar in patients with predominantly cognitive-affective and with predominantly somatic depression. However, ESS correlated only with cognitive-affective BDI, and younger age was independently associated with cognitive-affective BDI. Conversely, female sex and thymectomy were independently associated with somatic BDI. CONCLUSIONS Depression and fatigue are highly prevalent and largely overlapping comorbidities in MG, but only fatigue increased with disease severity, and only depression was milder in thymectomized patients. Comparative use of BDI subscales in MG reveals distinct depression phenotypes with distinct correlations to other disease features.
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Affiliation(s)
- Yury V Gavrilov
- Department of General Pathology and Pathological Physiology, Institute of Experimental Medicine, 197376, St. Petersburg, Russia
| | - Tatjana M Alekseeva
- Department of Neurology and Psychiatry, Almazov National Medical Research Centre, 197341, St. Petersburg, Russia
| | - Olga A Kreis
- Department of Neurology and Psychiatry, Almazov National Medical Research Centre, 197341, St. Petersburg, Russia.,Department of Neurology, North-Western State Medical University, 191015, St. Petersburg, Russia
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland.,Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland
| | - Yulia Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland. .,Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091, Zurich, Switzerland.
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Prevalence and Associated Factors of Depressive Symptoms in Patients with Myasthenia Gravis: A Cross-Sectional Study of Two Tertiary Hospitals in Riyadh, Saudi Arabia. Behav Neurol 2019; 2019:9367453. [PMID: 31636730 PMCID: PMC6766166 DOI: 10.1155/2019/9367453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/24/2019] [Accepted: 09/06/2019] [Indexed: 01/13/2023] Open
Abstract
Objectives This study is aimed at elucidating the prevalence of depression in patients with myasthenia gravis (MG) and examining the risk factors associated with depression. Methods We evaluated adult patients with MG who were recruited from two tertiary hospitals in the central region (Riyadh) of Saudi Arabia. Data were collected with a two-part standardized questionnaire: the first part included data on sociodemographic and clinical features of MG including disease type and duration, therapies, prednisolone dose, time of the last relapse, previous critical care unit admissions, MG status (controlled, partially controlled, or uncontrolled), and comorbid diseases; the second part included items from the previously validated Arabic version of the Patient Health Questionnaire-9 (PHQ-9). Results In total, 104/150 (69.3%) patients participated (72 females) with a mean age of 38.0 ± 16.0 years. The mean PHQ-9 score was 7.02 ± 6.1. Among all the participants, 27 (26.0%) patients had depression (PHQ-9 ≥ 10). Multiple logistic regression analysis revealed that uncontrolled MG status (OR = 12.31, 95%CI = 1.13-133.8, P = 0.04) was the only factor independently associated with depression. Collectively, the prevalence of depression among patients of the primary care clinics (PCC) as reported by 5 previous studies across multiple regions of the country was 15.8%. The odds of depression among MG patients were twofold higher than those among PCC patients (OR = 2.05, 95%CI = 1.30-3.22, P = 0.002). Conclusions Approximately a quarter of MG patients have depression. Achieving a minimal manifestation or better MG status may decrease the depression rate in these patients.
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Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol 2019; 27:204-209. [PMID: 31408565 DOI: 10.1111/ene.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. METHODS In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. RESULTS Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). CONCLUSIONS A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.
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Affiliation(s)
- A Bogdan
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - C Barnett
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - A Ali
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - M AlQwaifly
- College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - A Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Mannan
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - E Ng
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - V Bril
- Division of Neurology, Department of Medicine, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
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15
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Schneider-Gold C, Hagenacker T, Melzer N, Ruck T. Understanding the burden of refractory myasthenia gravis. Ther Adv Neurol Disord 2019; 12:1756286419832242. [PMID: 30854027 PMCID: PMC6399761 DOI: 10.1177/1756286419832242] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/28/2019] [Indexed: 11/15/2022] Open
Abstract
Myasthenia gravis (MG) is an autoantibody-mediated disease that compromises the acetylcholine receptors or associated structures of the postsynaptic membrane of the neuromuscular junction. This leads to impaired neuromuscular transmission and subsequent fluctuating fatigability and weakness of ocular, bulbar, and limb skeletal muscles. Over the past few decades, there have been significant advances in our understanding of the disease pathophysiology and improvements in prognosis due to intensive care medicine and immunomodulation. Despite this, an estimated 10-20% of patients with MG do not achieve an adequate response, are intolerant to conventional treatment, or require chronic treatment with intravenous immunoglobulins or plasma separation procedures. Such patients are regarded as having MG that is 'refractory' to treatment and may represent a distinct clinical subgroup. Because the majority of patients with MG have well-controlled disease, the burden of illness in the minority with refractory disease is poorly understood and may be underestimated. However, clinically these patients are liable to experience extreme fatigue, considerable disability owing to uncontrolled symptoms, and frequent myasthenic crises and hospitalizations. Both acute adverse effects and an increased risk of comorbidity from treatment regimens may contribute to reduced quality of life. As yet, little is known concerning the impact of refractory MG on mental health and health-related quality of life. This review aims to highlight the burden of disease and unmet needs in patients with refractory MG.
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Affiliation(s)
- Christiane Schneider-Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, Bochum, D-44791, Germany
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16
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Chu HT, Tseng CC, Liang CS, Yeh TC, Hu LY, Yang AC, Tsai SJ, Shen CC. Risk of Depressive Disorders Following Myasthenia Gravis: A Nationwide Population-Based Retrospective Cohort Study. Front Psychiatry 2019; 10:481. [PMID: 31354544 PMCID: PMC6629932 DOI: 10.3389/fpsyt.2019.00481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/19/2019] [Indexed: 12/19/2022] Open
Abstract
The chronic autoimmune disease myasthenia gravis (MG) is characterized by fluctuating muscle weakness, which can lead to a large amount of stress in the patient. The current investigation plans to assess the risk of depressive disorders in MG patients. A retrospective cohort study of patients ageing 20 years and older and also newly diagnosed with MG between January 1, 2000, and December 31, 2008, was conducted from the National Health Insurance Research Database (NHIRD) in Taiwan. Observations of all 349 MG patients and 1,396 control individuals were made until a diagnosis of a depressive disorder by a psychiatrist, until death, or until December 31, 2013. A range of comorbidities were found, such as coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia, with cerebrovascular disease being reported more frequently in MG patients in comparison with control subjects. After adjustment of patients' sex, age, urbanization, comorbidities, and monthly income, results indicated that MG individuals are 1.94 times more at risk (95% confidence interval [CI], 1.15-3.27, P = 0.014) of developing depressive disorders than are controls. This showed an increased risk in the development of depressive disorders in people with MG. Thus, depressive symptoms in MG patients should be regularly assessed.
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Affiliation(s)
- Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chieh Tseng
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
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17
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Liu Y, Tang X. Depressive Syndromes in Autoimmune Disorders of the Nervous System: Prevalence, Etiology, and Influence. Front Psychiatry 2018; 9:451. [PMID: 30319458 PMCID: PMC6168717 DOI: 10.3389/fpsyt.2018.00451] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/30/2018] [Indexed: 12/20/2022] Open
Abstract
Autoimmune diseases of the nervous system (ADNS) consist of a group of severely disabling disorders characterized by abnormal immune attack against protein components of the nervous system. This type of attack behavior may occur in the central or peripheral nervous system, and in the neuromuscular junction, resulting in neuronal damage, axonal injury, demyelination or destruction of the neuromuscular junction. While the neurological deficits of patients with ADNS have received significant research attention, the manifestation of depression tends to be ignored. In fact, depressive manifestation is common in ADNS and adds significant burden upon patients suffering from this disease. Here, we systematically reviewed the current literature to highlight the prevalence, etiology and influence of depressive manifestation in ADNS. Most autoimmune diseases of the nervous system are discussed in this paper, from multiple sclerosis, acute disseminated encephalomyelitis and autoimmune encephalitis to acute myelitis, neuromyelitis optica, Guillain-Barré syndrome and myasthenia gravis. Depressive symptoms usually develop as a comorbidity during the course of disease, but sometimes exist as a primary presentation of the disease. Psychosocial factors, long periods of disablement and chronic pain are the three most common causes of depressive symptoms in many chronic conditions, particularly in peripheral neuropathy. Furthermore, the higher prevalence of depressive symptoms in ADNS suggests that immunological dysregulation may contribute to the elevated morbidity of depression. Finally, structural lesions of the brain, and some medications for ADNS, are also thought to precipitate depressive states in ADNS.
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Affiliation(s)
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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18
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Miao X, Lian Z, Liu J, Chen H, Shi Z, Li M, Zhou H, Hu X, Yang R. Translation, cross-cultural adaptation, and validation of the chinese version of the 15-item myasthenia gravis quality of life questionnaire. Muscle Nerve 2018; 59:95-99. [PMID: 30055010 DOI: 10.1002/mus.26313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We sought to translate, cross-culturally adapt, and evaluate the internal consistency and validity of the Chinese version of the 15-Item Myasthenia Gravis Quality of Life (MG-QOL15). METHODS Translation and cross-cultural adaptation of the MG-QOL15 were performed. We used Cronbach's α to test internal consistency, one-way analysis of variance to test construct validity, and Pearson or Spearman correlations to test discriminant and concurrent validity. RESULTS We enrolled 168 outpatients. Internal consistency was excellent (Cronbach's α = 0.928). The MG-QOL15 discriminated MG severity as stratified by the MG Composite (MGC; P < 0.001) and Osserman class (P = 0.01). Concurrent validity was low to moderate with the subscales of the 36-item Short Form (-0.31 to ∼-0.59), MGC (r = 0.46), and Myasthenia Gravis Activities of Daily Living profile (r = 0.54). DISCUSSION The Chinese MG-QOL15 showed comparable construct, discriminant and concurrent validity, and internal consistency with to the original version. Muscle Nerve 59:95-99, 2019.
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Affiliation(s)
- Xiaohui Miao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhiyun Lian
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ju Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Mier Li
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuying Hu
- Department of Nursing, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Rong Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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19
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Purnamawati K, Ong JAH, Deshpande S, Tan WKY, Masurkar N, Low JK, Drum CL. The Importance of Sex Stratification in Autoimmune Disease Biomarker Research: A Systematic Review. Front Immunol 2018; 9:1208. [PMID: 29915581 PMCID: PMC5994590 DOI: 10.3389/fimmu.2018.01208] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022] Open
Abstract
The immune system is highly dynamic and regulated by many baseline characteristic factors. As such, significant variability may exist among different patient groups suffering from the same autoimmune disease (AD). However, contemporary research practices tend to take the reductionist aggregate approach: they do not segment AD patients before embarking on biomarker discovery. This approach has been productive: many novel AD biomarkers have recently been discovered. Yet, subsequent validation studies of these biomarkers tend to suffer from a lack of specificity, sensitivity, and reproducibility which hamper their translation for clinical use. To enhance reproducibility in validation studies, an optimal discovery-phase study design is paramount: one which takes into account different parameters affecting the immune system biology. In this systematic review, we highlight need for stratification in one such parameter, i.e., sex stratification. We will first explore sex differences in immune system biology and AD prevalence, followed by reported sex-bias in the clinical phenotypes of two ADs—one which more commonly affects females: systemic lupus erythematosus, and one which more commonly affects males: ankylosing spondylitis. The practice of sex stratification in biomarker research may not only advance the discovery of sex-specific AD biomarkers but more importantly, promote reproducibility in subsequent validation studies, thus easing the translation of these novel biomarkers from bench to bedside to improve AD diagnosis. In addition, such practice will also promote deeper understanding for differential AD pathophysiology in males and females, which will be useful for the development of more effective interventions for each sex type.
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Affiliation(s)
- Kristy Purnamawati
- Biomedical Institute for Global Health Research and Technology (BIGHEART), National University of Singapore (NUS), Singapore, Singapore
| | | | | | | | | | | | - Chester Lee Drum
- National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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20
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Tong O, Delfiner L, Herskovitz S. Pain, Headache, and Other Non-motor Symptoms in Myasthenia Gravis. Curr Pain Headache Rep 2018; 22:39. [DOI: 10.1007/s11916-018-0687-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Murai H, Utsugisawa K, Nagane Y, Suzuki S, Imai T, Motomura M. Rationale for the clinical guidelines for myasthenia gravis in Japan. Ann N Y Acad Sci 2018; 1413:35-40. [PMID: 29377151 DOI: 10.1111/nyas.13544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
Abstract
According to the 2014 Japanese clinical guidelines for myasthenia gravis, the most important priority in treatment is maintaining patients' health-related quality of life. Therefore, the initial treatment goal is defined as maintaining a postintervention status of minimal manifestations or better (according to the Myasthenia Gravis Foundation of America classification) with an oral prednisolone dose of 5 mg/day or less. Every effort should be made to attain this level as rapidly as possible. To achieve this goal, the guidelines recommend minimizing the oral prednisolone dose, starting calcineurin inhibitors early in the course of treatment, using intravenous methylprednisolone infusion judiciously (often combined with plasma exchange/plasmapheresis or intravenous immunoglobulin), and effectively treating patients with an early, fast-acting treatment strategy. The early, fast-acting treatment strategy enables more frequent and earlier attainment of the initial goal than other strategies. Thymectomy is considered an option for treating nonthymomatous early-onset myasthenia gravis in patients with antiacetylcholine receptor antibodies and thymic hyperplasia in the early stages of the disease.
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Affiliation(s)
- Hiroyuki Murai
- Department of Neurology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | - Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tomihiro Imai
- Department of Occupational Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Masakatsu Motomura
- Medical Engineering Course, Department of Engineering, The Faculty of Engineering, Nagasaki Institute of Applied Science, Nagasaki, Japan
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22
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Sabre L, Westerberg E, Liik M, Punga AR. Diversity in mental fatigue and social profile of patients with myasthenia gravis in two different Northern European countries. Brain Behav 2017; 7:e00653. [PMID: 28413704 PMCID: PMC5390836 DOI: 10.1002/brb3.653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Self-estimated health can be used for comparison of different diseases between countries. It is important to elaborate on whether disparities in self-estimated health are due to disease-specific parameters or socioeconomic differences. In this study, we aimed at evaluating clinical and social similarities and differences in myasthenia gravis (MG) patients between comparable regions in two Baltic Sea countries, Estonia and Sweden. METHODS This cross-sectional study included southern counties in Sweden and Estonia of comparable size. All patients with a confirmed MG diagnosis were asked to answer two questionnaires including demographic and disease-specific data, lifestyle issues, and mental fatigue (Fatigue Severity Scale [FSS]). Clinical fatigue was assessed objectively through the Quantitative Myasthenia Gravis Score (QMG). RESULTS Thirty-six of 92 identified patients in Estonia and 40 of 70 identified MG patients in Sweden chose to participate in the study. The demographic characteristics and symptoms reported by the patients were similar. QMG score did not differ; however, the Estonian patients scored their current subjective disease severity significantly higher (5.6 ± 2.8) compared to the Swedish patients (3.4 ± 2.3, p = .0005). Estonian patients also had significantly higher FSS scores (5.0 ± 1.7) than Swedish patients (3.5 ± 1.6; p = .001). Swedish patients were more active and performed physical activity more regularly (29.1% in Estonia and 74.2% in Sweden, p = .004). CONCLUSIONS Although, the patients had comparable clinical fatigue, Estonian patients evaluated their health state as being more severe and reported more mental fatigue than Swedish patients. These data indicate large regional differences in disease perception of MG, which is important to consider in international studies.
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Affiliation(s)
- Liis Sabre
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden.,Department of Neurology Tartu University Hospital Tartu Estonia
| | - Elisabet Westerberg
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden
| | - Maarika Liik
- Department of Neurology Tartu University Hospital Tartu Estonia
| | - Anna R Punga
- Department of Neuroscience, Clinical Neurophysiology Uppsala University and Uppsala University Hospital Uppsala Sweden
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23
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Nagane Y, Murai H, Imai T, Yamamoto D, Tsuda E, Minami N, Suzuki Y, Kanai T, Uzawa A, Kawaguchi N, Masuda M, Konno S, Suzuki H, Aoki M, Utsugisawa K. Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study. BMJ Open 2017; 7:e013278. [PMID: 28235967 PMCID: PMC5337722 DOI: 10.1136/bmjopen-2016-013278] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To clarify the social disadvantages associated with myasthenia gravis (MG) and examine associations with its disease and treatment. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We evaluated 917 consecutive cases of established MG seen at 13 neurological centres in Japan over a short duration. OUTCOME MEASURES All patients completed a questionnaire on social disadvantages resulting from MG and its treatment and a 15-item MG-specific quality of life scale at study entry. Clinical severity at the worst condition was graded according to the MG Foundation of America classification, and that at the current condition was determined according to the quantitative MG score and MG composite. Maximum dose and duration of dose ≥20 mg/day of oral prednisolone during the disease course were obtained from the patients' medical records. Achievement of the treatment target (minimal manifestation status with prednisolone at ≤5 mg/day) was determined at 1, 2 and 4 years after starting treatment and at study entry. RESULTS We found that 27.2% of the patients had experienced unemployment, 4.1% had been unwillingly transferred and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was ≥50% of their previous total income. In addition, 49.0% of the patients reported feeling reduced social positivity. Factors promoting social disadvantages were severity of illness, dose and duration of prednisolone, long-term treatment, and a depressive state and change in appearance after treatment with oral steroids. Early achievement of the treatment target was a major inhibiting factor. CONCLUSIONS Patients with MG often experience unemployment, unwilling job transfers and a decrease in income. In addition, many patients report feeling reduced social positivity. To inhibit the social disadvantages associated with MG and its treatment, greater focus needs to be placed on helping patients with MG resume a normal lifestyle as soon as possible by achieving the treatment target.
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Affiliation(s)
- Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
| | - Hiroyuki Murai
- Department of Neurological Therapeutics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomihiro Imai
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Daisuke Yamamoto
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Emiko Tsuda
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Naoya Minami
- Department of Neurology, Hokkaido Medical Center, Sapporo, Japan
| | - Yasushi Suzuki
- Department of Neurology, Sendai Medical Center, Sendai, Japan
| | - Tetsuya Kanai
- Department of Neurology, Chiba University School of Medicine, Chiba, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Chiba University School of Medicine, Chiba, Japan
| | | | - Masayuki Masuda
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Shingo Konno
- Department of Neurology, Toho University Oh-hashi Medical Center, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Neurology, Kinki University School of Medicine, Osaka, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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24
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Utsugisawa K, Nagane Y, Akaishi T, Suzuki Y, Imai T, Tsuda E, Minami N, Uzawa A, Kawaguchi N, Masuda M, Konno S, Suzuki H, Murai H, Aoki M. Early fast-acting treatment strategy against generalized myasthenia gravis. Muscle Nerve 2017; 55:794-801. [PMID: 27603432 PMCID: PMC5484288 DOI: 10.1002/mus.25397] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION In this study we sought to clarify the effects of early fast-acting treatment (EFT) strategies on the time course for achieving the treatment target in generalized myasthenia gravis (MG). METHODS This retrospective study of 923 consecutive MG patients analyzed 688 generalized MG patients who had received immunotherapy during the disease course. The time to first achieve minimal manifestations (MM) or better while receiving prednisolone at ≤5 mg/day for ≥6 months (MM-or-better-5mg) up to 120 months after starting immunotherapy was compared between EFT and non-EFT patients. RESULTS Achievement of MM-or-better-5mg was more frequent and earlier in the EFT group (P = 0.0004, Wilcoxon test; P = 0.0001, log-rank test). Multivariate Cox regression analysis calculated a hazard ratio of 1.98 (P < 0.0001) for utilization of EFT. Dosing regimens of oral steroids in EFT produced no differences in the time course. CONCLUSIONS EFT strategies are advantageous for early achievement of MM-or-better-5mg. Muscle Nerve 55: 794-801, 2017.
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Affiliation(s)
- Kimiaki Utsugisawa
- Department of Neurology, Hanamaki General Hospital, 4-28, Kajoh-chou, Hanamaki, 025-0075, Japan
| | - Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, 4-28, Kajoh-chou, Hanamaki, 025-0075, Japan
| | - Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasushi Suzuki
- Department of Neurology, Sendai Medical Center, Sendai, Japan
| | - Tomihiro Imai
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Emiko Tsuda
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Naoya Minami
- Department of Neurology, Hokkaido Medical Center, Sapporo, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Chiba University School of Medicine, Chiba, Japan
| | | | - Masayuki Masuda
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Shingo Konno
- Department of Neurology, Toho University Oh-hashi Medical Center, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Neurology, Kinki University School of Medicine, Osaka, Japan
| | - Hiroyuki Murai
- Department of Neurological therapeutics, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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25
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Myasthenia gravis and psychiatric comorbidities. MIDDLE EAST CURRENT PSYCHIATRY 2016. [DOI: 10.1097/01.xme.0000481469.56478.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Yang Y, Zhang M, Guo J, Ma S, Fan L, Wang X, Li C, Guo P, Wang J, Li H, Li Z. Quality of life in 188 patients with myasthenia gravis in China. Int J Neurosci 2015; 126:455-62. [PMID: 26000922 DOI: 10.3109/00207454.2015.1038712] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myasthenia gravis (MG) is a kind of chronic autoimmune disease which can weaken patients' motor function and, furthermore, produce negative impact on the health-related quality of life (HRQoL). The primary purpose of this research was to evaluate factors that might affect the HRQoL of MG patients. A cross-sectional clinical research was carried out including 188 successive patients with MG. Myasthenia Gravis Foundation of America (MGFA) classification and Quantitative Myasthenia Gravis (QMG) score were applied to assess the severity of the disease. The Medical Outcome Survey 36-Item Short-Form Health Survey (SF-36) was used to estimate the HRQoL. Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) were utilized to measure the depression and anxiety symptom. Factors may influence the HRQoL of MG patients include age, educational level, occupation, the situation of the thymus, the type of MG and generalized myasthenia gravis (GMG), the severity of the disease and the psychological disorder. Higher QMG and HARS scores were two significant factors that can prognosticate lower Physical Composite Score (PCS) and Mental Composite Score (MCS), while older age was just a significant factor which has prognostic value for lower PCS. The results of this research may have a potential guiding significance for the clinical treatment strategy and improve the quality of life in patients with MG consequently. In addition to the treatment of physical symptoms, the psychological symptoms such as anxiety and depression should be concerned as well.
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Affiliation(s)
- Yongxiang Yang
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Min Zhang
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Jun Guo
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Shan Ma
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Lingling Fan
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Xianni Wang
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Chuan Li
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Peng Guo
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Jie Wang
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Hongzeng Li
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
| | - Zhuyi Li
- a Department of Neurology, Tangdu Hospital , Fourth Military Medical University , Xi'an , Shaanxi 710038 , China
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Blum S, Lee D, Gillis D, McEniery DF, Reddel S, McCombe P. Clinical features and impact of myasthenia gravis disease in Australian patients. J Clin Neurosci 2015; 22:1164-9. [PMID: 26021730 DOI: 10.1016/j.jocn.2015.01.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 12/21/2022]
Abstract
We performed a community-based survey of 165 Australian patients with a physician-confirmed diagnosis of myasthenia gravis (MG). MG is an autoimmune disease of the neuromuscular junction causing fatiguable muscle weakness. Patients with early onset MG (<40 years of age) were more frequently female (22 males, 60 females) whereas patients with late onset MG (>40 years of age) were more frequently male (50 males, 28 females; p < 0.001). Triggering and exacerbating factors included physical and emotional stress, infections, surgery or trauma, seasonal changes and medications. The co-occurrence of other immune-related diseases was reported by 54% of patients. The median MG quality of life (QOL) score was 92 (range: 24-186). The factor most strongly associated with poor QOL was depression. Only 40.6% of patients were working at the time of the survey and of these, almost half had required sick leave due to MG in the past 12 months. A further 39.4% had stopped work due to MG and 19.4% having to change occupation. Full-time or part-time care was required by 29% of patients and government financial support was received by 52.7%.
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Affiliation(s)
- Stefan Blum
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia; University of Queensland, Centre of Clinical Research, Herston, QLD, Australia.
| | - David Lee
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
| | - David Gillis
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia; Pathology Queensland, Herston, QLD, Australia
| | | | - Stephen Reddel
- University of Sydney, Concord Hospital, Concord, NSW, Australia
| | - Pamela McCombe
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia; University of Queensland, Centre of Clinical Research, Herston, QLD, Australia
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Murai H. Japanese clinical guidelines for myasthenia gravis: Putting into practice. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12180] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hiroyuki Murai
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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Utsugisawa K, Nagane Y, Imai T, Motomura M, Masuda M, Konno S, Suzuki S. Treatment of myasthenia gravis patients with calcineurin inhibitors in Japan: A retrospective analysis of outcomes. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Yuriko Nagane
- Department of Neurology; Hanamaki General Hospital; Hanamaki Japan
| | - Tomihiro Imai
- Sapporo Medical University School of Health Sciences; Sapporo Japan
| | - Masakatsu Motomura
- First Department of Internal Medicine; Graduate School of Biomedical Sciences; Nagasaki University; Nagasaki Japan
| | - Masayuki Masuda
- Department of Neurology; Tokyo Medical University; Tokyo Japan
| | - Shingo Konno
- Department of Neurology; Toho University Medical Center Oh-hashi Hospital; Tokyo Japan
| | - Shigeaki Suzuki
- Department of Neurology; Keio University School of Medicine; Tokyo Japan
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30
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Jones SM, Gwathmey KG, Burns TM. Quality of life measures for myasthenia gravis and evaluation of non-motor symptoms. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cen3.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah M. Jones
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Kelly G. Gwathmey
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
| | - Ted M. Burns
- Department of Neurology; University of Virginia; Charlottesville Virginia USA
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31
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Utsugisawa K, Suzuki S, Nagane Y, Masuda M, Murai H, Imai T, Tsuda E, Konno S, Nakane S, Suzuki Y, Fujihara K, Suzuki N. Health-related quality-of-life and treatment targets in myasthenia gravis. Muscle Nerve 2014; 50:493-500. [DOI: 10.1002/mus.24213] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 02/05/2014] [Accepted: 02/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Kimiaki Utsugisawa
- Department of Neurology; Hanamaki General Hospital; 4-28 Kajoh-chou Hanamaki 025-0075 Japan
| | - Shigeaki Suzuki
- Department of Neurology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
| | - Yuriko Nagane
- Department of Neurology; Hanamaki General Hospital; 4-28 Kajoh-chou Hanamaki 025-0075 Japan
| | - Masayuki Masuda
- Department of Neurology; Tokyo Medical University; Tokyo Japan
| | | | - Tomihiro Imai
- Department of Neurology; Sapporo Medical University Hospital; Sapporo Japan
| | - Emiko Tsuda
- Department of Neurology; Sapporo Medical University Hospital; Sapporo Japan
| | - Shingo Konno
- Department of Neurology; Toho University Medical Center Oh-hashi Hospital; Tokyo Japan
| | - Shunya Nakane
- Department of Neurology; Nagasaki Kawatana Medical Center; Higashi-Sonogi-Gun Japan
| | - Yasushi Suzuki
- Department of Neurology; Sendai Medical Center; Sendai Japan
| | - Kazuo Fujihara
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Norihiro Suzuki
- Department of Neurology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
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Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol 2014; 35:347-69. [PMID: 24793874 DOI: 10.1016/j.yfrne.2014.04.004] [Citation(s) in RCA: 583] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.
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Affiliation(s)
- S T Ngo
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia; University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
| | - F J Steyn
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - P A McCombe
- University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
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33
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Nagane Y. [Clinical factors affecting quality of life and treatment targets in patients with myasthenia gravis]. Rinsho Shinkeigaku 2013; 53:1299-302. [PMID: 24291967 DOI: 10.5692/clinicalneurol.53.1299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Presently, myasthenia gravis (MG) is seldom lethal. However, full remission without immune treatment is not common, and many patients still find it difficult to maintain daily activities. To both determine factors affecting health-related quality of life (QOL) and propose an appropriate treatment target for patients with MG, we evaluated 640 consecutive patients with MG seen at 11 neurological centers. Two-year follow-up data were obtained for 282 patients. Correlations between detailed clinical facotrs and the Japanese version of the 15-item MG-specific QOL scale were analyzed.In the cross-sectional analysis of 640 MG patients, multivariate regression revealed that disease severity as evaluated by MG Composite (p < 0.0001), but not quantitative MG score, total dose of oral prednisolone (p = 0.002), but not current dose, and Cushingoid appearance index (p = 0.0004) showed significant negative effects on QOL. Achieving status of Minimal Manifestations or better with prednisolone ≤ 5 mg/day was found to exert a major positive impact on QOL in both the cross-sectional and 2-year follow-up patient samples and can be recommended as a treatment target.
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Mourao AM, Araujo CM, Barbosa LSM, Gomez RS, Burns TM, Lemos SMA, Teixeira AL. Brazilian cross-cultural translation and adaptation of the "Questionnaire of Life Quality Specific for Myasthenia Gravis - 15 items". ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:955-8. [DOI: 10.1590/0004-282x20130180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/17/2013] [Indexed: 11/22/2022]
Abstract
Objective To translate and to perform the cross-cultural adaptation of the “Questionnaire of Life Quality Specific for Myasthenia Gravis - 15 items” (MG-QOL15). Method The original English version of the questionnaire was translated into Portuguese. This version was revised and translated back into English. Later, both English versions were compared and the divergences were corrected in the Portuguese text. At a second stage, ten patients with MG followed at the Neuromuscular Diseases Clinic from the University Hospital, Universidade Federal de Minas Gerais answered the questionnaire. The authors analyzed the difficulties and misunderstandings in the application of the questionnaire. Results The questions 8, 13 and 15 were considered difficult to understand and were modified in the final Portuguese version. Most patients (70%) had a total score above 25, and the statements 3, 8 and 9 showed the highest scores. Conclusion The Brazilian version of the questionnaire MG-QOL15 seems to be a promising tool for the assessment of Brazilian patients with MG.
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Wang YP, Gorenstein C. Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II. Clinics (Sao Paulo) 2013; 68:1274-87. [PMID: 24141845 PMCID: PMC3782729 DOI: 10.6061/clinics/2013(09)15] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/02/2013] [Indexed: 11/27/2022] Open
Abstract
To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.
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Affiliation(s)
- Yuan-Pang Wang
- Department of Psychiatry (LIM-23), Medical School, University of São Paulo, São PauloSP, Brazil
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36
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masuda M, Utsugisawa K, Suzuki S, Nagane Y, Kabasawa C, Suzuki Y, Shimizu Y, Utsumi H, Fujihara K, Uchiyama S, Suzuki N. The MG-QOL15 Japanese version: Validation and associations with clinical factors. Muscle Nerve 2012; 46:166-73. [DOI: 10.1002/mus.23398] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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