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Inoue H, Yamada K, Fujii A, Tomonari T, Mizuno K, Mita K, Higuchi O, Akao M, Matsukawa N. A Patient with Fulminant Myasthenia Gravis Is Seropositive for Both AChR and LRP4 Antibodies, Complicated by Autoimmune Polyglandular Syndrome Type 3. Intern Med 2020; 59:2177-2181. [PMID: 32461531 PMCID: PMC7516320 DOI: 10.2169/internalmedicine.4708-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This article describes the first reported case of myasthenia gravis (MG) seropositive for both acetylcholine receptor antibody and low-density lipoprotein receptor-related protein 4 antibody, complicated by autoimmune polyglandular syndrome (APS) type 3. The patient exhibited myasthenic weakness restricted to the ocular muscles and ptosis. Severe clinical deterioration ensued with predominant bulbar symptoms. MG rapidly worsened, the patient was intubated, and agranulocytosis due to thiamazole was also present, so it was necessary to perform thyroidectomy with tracheostomy and thymectomy in two phases. Both the double-seropositive MG and the APS were involved in the patient's rapid deterioration.
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Affiliation(s)
- Hiroyasu Inoue
- Department of Neurology, Nagoya City East Medical Center, Japan
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kentaro Yamada
- Department of Neurology, Nagoya City East Medical Center, Japan
| | - Asami Fujii
- Department of Diabetes & Endocrinology, Nagoya City East Medical Center, Japan
| | - Tatsuya Tomonari
- Department of Nephrology, Nagoya City East Medical Center, Japan
| | - Kotaro Mizuno
- Department of Surgery, Nagoya City East Medical Center, Japan
| | - Keiko Mita
- Department of Surgery, Nagoya City East Medical Center, Japan
| | - Osamu Higuchi
- Department of Clinical Research, Nagasaki Kawatana Medical Center, Japan
| | - Masaya Akao
- Department of Diabetes & Endocrinology, Nagoya City East Medical Center, Japan
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
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Chen J, Chen Z, Miao F, Song Y, Chen G, Zhu Y, Pang L, Xi J, Zhao C, Chen X. A Randomized Control Study on the Efficacy of Thymectomy in Patients with Nonthymomatous (without Chest Tumor) Myasthenia Gravis. Ann Indian Acad Neurol 2020; 23:141-144. [PMID: 32055143 PMCID: PMC7001440 DOI: 10.4103/aian.aian_138_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ji Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiming Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Miao
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Song
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongjun Zhu
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chongbo Zhao
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofeng Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Cai X, Li Z, Xi J, Song H, Liu J, Zhu W, Guo Y, Jiao Z. Myasthenia gravis and specific immunotherapy: monoclonal antibodies. Ann N Y Acad Sci 2019; 1452:18-33. [PMID: 31393614 DOI: 10.1111/nyas.14195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Xiao‐Jun Cai
- Department of Clinical Pharmacy, Huashan HospitalFudan University Shanghai P. R. China
- Department of Pharmacythe Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi P. R. China
| | - Zai‐Wang Li
- Department of Neurology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan Universitythe First Affiliated Hospital of Southern University of Science and Technology Shenzhen P. R. China
- Department of Neurologythe Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi P. R. China
| | - Jian‐Ying Xi
- Department of Neurology, Huashan HospitalFudan University Shanghai P. R. China
| | - Hui‐Zhu Song
- Department of Pharmacythe Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi P. R. China
| | - Jue Liu
- Department of Clinical Pharmacy, Huashan HospitalFudan University Shanghai P. R. China
| | - Wen‐Hua Zhu
- Department of Neurology, Huashan HospitalFudan University Shanghai P. R. China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan Universitythe First Affiliated Hospital of Southern University of Science and Technology Shenzhen P. R. China
| | - Zheng Jiao
- Department of Clinical Pharmacy, Huashan HospitalFudan University Shanghai P. R. China
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Li HF, Hong Y, Xie Y, Hao HJ, Sun RC. Precision medicine in myasthenia graves: begin from the data precision. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:106. [PMID: 27127759 DOI: 10.21037/atm.2016.02.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myasthenia gravis (MG) is a prototypic autoimmune disease with overt clinical and immunological heterogeneity. The data of MG is far from individually precise now, partially due to the rarity and heterogeneity of this disease. In this review, we provide the basic insights of MG data precision, including onset age, presenting symptoms, generalization, thymus status, pathogenic autoantibodies, muscle involvement, severity and response to treatment based on references and our previous studies. Subgroups and quantitative traits of MG are discussed in the sense of data precision. The role of disease registries and scientific bases of precise analysis are also discussed to ensure better collection and analysis of MG data.
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Affiliation(s)
- Hai-Feng Li
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yu Hong
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Yanchen Xie
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Hong-Jun Hao
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
| | - Ren-Cheng Sun
- 1 Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China ; 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway ; 3 Department of Neurology, The George Washington University, Washington, DC, USA ; 4 Department of Neurology, Peking University First Hospital, Beijing 100034, China ; 5 College of Information and Engineering, Qingdao University, Qingdao 266071, China
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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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Abstract
BACKGROUND Treatments currently used for patients with myasthenia gravis (MG) include steroids, non-steroid immune suppressive agents, plasma exchange, intravenous immunoglobulin and thymectomy. Data from randomized controlled trials (RCTs) support the use of some of these therapeutic modalities and the evidence for non-surgical therapies are the subject of other Cochrane reviews. Significant uncertainty and variation persist in clinical practice regarding the potential role of thymectomy in the treatment of people with MG. OBJECTIVES To assess the efficacy and safety of thymectomy in the management of people with non-thymomatous MG. SEARCH METHODS On 31 March 2013, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2013, Issue 3), MEDLINE (January 1966 to March 2013), EMBASE (January 1980 to March 2013) and LILACS (January 1992 to March 2013) for RCTs. Two authors (RS and GC) read all retrieved abstracts and reviewed the full texts of potentially relevant articles. These two authors checked references of all manuscripts identified in the review to identify additional articles that were of relevance and contacted experts in the field to identify additional published and unpublished data. Where necessary, authors were contacted for further information. SELECTION CRITERIA Randomized or quasi-randomized controlled trials of thymectomy against no treatment or any medical treatment, and thymectomy plus medical treatment against medical treatment alone, in people with non-thymomatous MG.We did not use measured outcomes as criteria for study selection. DATA COLLECTION AND ANALYSIS We planned that two authors would independently extract data onto a specially designed data extraction form and assess risk of bias; however, there were no included studies in the review. We would have identified any adverse effects of thymectomy from the included trials. MAIN RESULTS We did not identify any RCTs testing the efficacy of thymectomy in the treatment of MG. In the absence of data from RCTs, we were unable to do any further analysis. AUTHORS' CONCLUSIONS There is no randomized controlled trial literature that allows meaningful conclusions about the efficacy of thymectomy on MG. Data from several class III observational studies suggest that thymectomy could be beneficial in MG. An RCT is needed to elucidate if thymectomy is useful, and to what extent, in MG.
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Affiliation(s)
- Gabriel Cea
- Departamento de Neurosciencias, Hospital del Salvador, Universidad de Chile, Avda Salvador 364, Providencia, Santiago, Chile, 6640517
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Ponseti JM, Gamez J, Vilallonga R, Ruiz C, Azem J, López-Cano M, Armengol M. Influence of ectopic thymic tissue on clinical outcome following extended thymectomy in generalized seropositive nonthymomatous myasthenia gravis. Eur J Cardiothorac Surg 2008; 34:1062-7. [DOI: 10.1016/j.ejcts.2008.07.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/18/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022] Open
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Abstract
OBJECTIVES To examine myasthenia gravis (MG) severity and long-term prognosis in seronegative, seropositive, and thymoma MG. MATERIALS AND METHODS Four series of patients were studied retrospectively. Severity and treatment were assessed each year, and muscle antibodies were assayed. RESULTS Seropositive MG patients had a more severe course than seronegative MG patients. MG severity was higher in non-thymectomized compared to thymectomized early-onset MG patients. MG severity did not differ between thymectomized and non-thymectomized late-onset patients. There was no significant difference in MG severity between thymoma and non-thymoma MG patients. CONCLUSIONS MG is more severe in seropositive MG patients. With proper treatment, especially early thymectomy, the long-term prognosis is good in seropositive MG patients. The present studies indicate a benefit of thymectomy in early-onset MG, but no dramatic benefit in late-onset MG. Similar MG severity and outcome was seen in thymoma and non-thymoma MG.
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Affiliation(s)
- F Romi
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Téllez-Zenteno JF, Cardenas G, Estañol B, Garcia-Ramos G, Weder-Cisneros N. Associated conditions in myasthenia gravis: response to thymectomy. Eur J Neurol 2005; 11:767-73. [PMID: 15525299 DOI: 10.1111/j.1468-1331.2004.00968.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To compare the response of thymectomy in patients with associated conditions (PWAC) and without associated conditions (PWOAC). Comparative, retrospective. 198 patients with the established diagnosis of myasthenia gravis who had a thymectomy between 1987 and 2000, and who were folowed up for at least 3 years. We formed two groups, one with associated conditions and the second without associated conditions. The patients were divided into four groups: (i) patients in remission, (ii) patients with improvement, (iii) patients without changes, and (iv) patients whose condition worsened. Associated conditions (AC) were found in 49 patients (26%). The main associated conditions were hyperthyroidism in 16 patients (33%) hypothyroidism in seven (14%), rheumatoid arthritis in five (10%) and hypothyroidism and Sjogren syndrome in three (6%). Concerning the response of thymectomy, 13 patients WAC showed remission (27%), vs. 54 patients WOAC (39%). Twenty patients WAC showed improvement (41%) vs. 46 WOAC (33%). Thirteen patients WAC had no changes (27%) vs. 37 WOAC (26%). Finally, in three patients WAC their condition worsened (6%) vs. three WOAC (2%). The response to thymectomy was high (69%) in both groups. We did not identify significant differences.
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Affiliation(s)
- J F Téllez-Zenteno
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Delegacion Tlalpan, Mexico.
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Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. Neurology 2004; 61:1362-6. [PMID: 14638956 DOI: 10.1212/01.wnl.0000082725.21444.ec] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of maternal myasthenia gravis (MG) on giving birth and on the newborn. METHODS A retrospective cohort study for 1967 through 2000 was undertaken, using data from the Medical Birth Registry of Norway, based on the compulsory notification of all births. The target group consisted of 127 births by mothers with MG. The reference group consisted of all 1.9 million births by mothers without MG. RESULTS Women with MG had a higher rate of complications at delivery (40.9% vs 32.9%, p = 0.05), and in particular the risk of preterm rupture of amniotic membranes was three times higher in the MG group compared to the reference group (5.5% vs 1.7%, p = 0.001). The rate of interventions during birth was raised (33.9% vs 20.0%, p < 0.001) and cesarean sections doubled (17.3% vs 8.6%, p = 0.001). Five children (3.9%) born by MG mothers had severe anomalies, and three of them died. CONCLUSIONS MG is associated with an increased risk for complications during delivery. This is linked to a higher occurrence of interventions during birth.
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Affiliation(s)
- Jana Midelfart Hoff
- Institute of Neurology, Department of Public Health and Primary Health Care, University of Bergen, Norway
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Romi F, Gilhus NE, Varhaug JE, Myking A, Aarli JA. Disease severity and outcome in thymoma myasthenia gravis: a long-term observation study. Eur J Neurol 2004; 10:701-6. [PMID: 14641516 DOI: 10.1046/j.1468-1331.2003.00678.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thymomas occurring in myasthenia gravis (MG) are usually of the cortical subtype and are usually treated by thymectomy. However, the factors that influence MG outcome in thymoma MG patients are not known. In a long-term study, MG severity and treatment was observed in 24 thymoma and 24 non-thymoma MG patients for up to 30 years, and the occurrence of muscle autoantibodies was assayed. The rate of complete stable remission was low and did not differ between the two groups. There was no significant difference in MG severity between thymoma and non-thymoma MG patients at any time during the study. Titin and ryanodine receptor (RyR) antibody occurrence was significantly higher in thymoma MG patients. Four thymoma (all titin and RyR antibody positive) and two non-thymoma (both titin and one RyR antibody positive) MG patients died from MG-related respiratory insufficiency. Seventy percent of thymoma and 75% of non-thymoma MG patients were treated with immunosuppressive drugs. The number of patients who received plasmapheresis did not differ in those who were treated because of acute MG deterioration, irrespective of planned surgery.This study shows equal MG severity and outcome in thymoma and non-thymoma MG, but the presence of RyR antibodies in thymoma MG and titin/RyR in non-thymoma MG indicates a less favorable prognosis.
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Affiliation(s)
- F Romi
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Abstract
Myasthenia gravis (MG) is a syndrome of fluctuating skeletal muscle weakness that worsens with use and improves with rest. Eye, facial, oropharyngeal, axial, and limb muscles may be involved in varying combinations and degrees of severity. Its etiology is heterogeneous, divided initially between those rare congenital myasthenic syndromes, which are genetic, and the bulk of MG, which is acquired and autoimmune. The autoimmune conditions are divided in turn between those that possess measurable serum acetylcholine receptor (AChR) antibodies and a smaller group that does not. The latter group includes those MG patients who have serum antibodies to muscle-specific tyrosine kinase (MuSK). Therapeutic considerations differ for early-onset MG, late-onset MG, and MG associated with the presence of a thymoma. Most MG patients can be treated effectively, but there is still a need for more specific immunological approaches.
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Affiliation(s)
- John C Keesey
- Department of Neurology, UCLA School of Medicine, Los Angeles, California, USA.
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