1
|
Li W, He L, Jin X, Li L, Sun C, Wang C. Isolated dysarthria as the sole manifestation of myasthenia gravis: a case report. J Int Med Res 2022; 50:3000605221109395. [PMID: 35915860 PMCID: PMC9350514 DOI: 10.1177/03000605221109395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Myasthenia gravis (MG) is an acquired autoimmune disease. Its clinical
manifestations comprise ptosis, diplopia, dysarthria, dysphagia, limb weakness,
and in severe cases, respiratory muscle involvement. Dysarthria as an exclusive
initial and primary complaint in MG is rare and seldom reported. In this paper,
we report a case of type IIIb MG with isolated dysarthria as the only clinical
manifestation and we review the relevant literature. The patient was a
62-year-old man who presented with episodes of slurred speech for 20 days that
had worsened in the previous 9 days. His medical history comprised hypertension,
diabetes mellitus, and coronary heart disease. The initial diagnosis on
admission was transient ischemic attack. Careful re-examination of the patient’s
history revealed that his symptoms mainly involved increasingly worse slurred
speech episodes without drinking or swallowing difficulties, and no significant
improvement with rest was observed. Electromyography and autoantibody profiling
led to a diagnosis of type IIIb MG. His symptoms improved after the oral
administration of pyridostigmine bromide 60 mg. Laryngeal MG is important to
differentiate from stroke. It is necessary to perform a computerized voice
analysis when encountering patients with atypical symptoms of MG.
Collapse
Affiliation(s)
- Wei Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Ling He
- Department of Neurology, Jilin Central General Hospital, Jilin, China
| | - Xiaodong Jin
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Li Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Congcong Sun
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cuilan Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
2
|
Ducci RDP, Kay CSK, Fustes OJH, Werneck LC, Lorenzoni PJ, Scola RH. Myasthenia gravis during pregnancy: what care should be taken? ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:624-629. [PMID: 34287508 DOI: 10.1590/0004-282x-anp-2020-0407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease in which the peak incidence is among women of childbearing age. For this reason, there is an overlap between the occurrence of this disease and pregnancy. It is known that MG symptoms can worsen during pregnancy and postpartum, and that pregnancy has special characteristics in MG patients. Children born to myasthenic mothers are at risk of having transient neonatal myasthenia. We briefly review the main relationships between MG and pregnancy, and we make recommendations for MG therapy, pregnancy, delivery, breastfeeding and newborns.
Collapse
Affiliation(s)
- Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Cláudia Suemi Kamoi Kay
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Otto Jesus Hernandez Fustes
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Lineu Cesar Werneck
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Paulo José Lorenzoni
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| | - Rosana Herminia Scola
- Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Doenças Neuromusculares, Curitiba PR, Brazil
| |
Collapse
|
3
|
Ayres A, Winckler PB, Jacinto-Scudeiro LA, Rech RS, Padovani MMP, Jotz GP, Olchik MR. Speech characteristics in individuals with myasthenia gravis: a case control study. LOGOP PHONIATR VOCO 2020; 47:35-42. [DOI: 10.1080/14015439.2020.1834614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Annelise Ayres
- Postgraduate Program in Health Sciences at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pablo Brea Winckler
- Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laís Alves Jacinto-Scudeiro
- Postgraduate Program in Medical Sciences at the Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafaela Soares Rech
- Speech Therapy Course, College of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Geraldo Pereira Jotz
- Postgraduate Program in Health Sciences at the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maira Rozenfeld Olchik
- Speech Therapy Course, College of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
4
|
Hernandez Fustes OJ, Arteaga Rodriguez C, Hernandez Fustes OJ. Myasthenia Gravis with Elderly Onset at Advanced Age. Cureus 2020; 12:e6808. [PMID: 32038895 PMCID: PMC6991148 DOI: 10.7759/cureus.6808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/29/2020] [Indexed: 11/17/2022] Open
Abstract
Myasthenia gravis (MG) in older adults has not been extensively studied. The prevalence of this disease in older people seems to be higher in recent epidemiological studies. In patients with disease onset after the age of 70, the diagnosis is more difficult as other conditions are more easily taken to be the causal element. The mortality is higher than in young patients, so prompt specific treatment can improve prognosis. We present an 85-year-old female patient with speech disturbance and difficulty in swallowing solids, and neurological examination with palpebral ptosis, disphonia, convergent strabismus and weakness and mild progressive fatigue in arms, with electroneuromyography and acetylcholine receptor antibody who was diagnosed with MG, emphasizing the importance of this entity in geriatric patients.
Collapse
|
5
|
He D, Zhang H, Xiao J, Zhang X, Xie M, Pan D, Wang M, Luo X, Bu B, Zhang M, Wang W. Molecular and clinical relationship between live-attenuated Japanese encephalitis vaccination and childhood onset myasthenia gravis. Ann Neurol 2019; 84:386-400. [PMID: 30246904 PMCID: PMC6175482 DOI: 10.1002/ana.25267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/12/2022]
Abstract
Objective The incidence of childhood onset myasthenia gravis (CMG) in China is higher than that in other countries; however, the reasons for this are unclear. Methods We investigated the clinical and immunological profiles of CMG, and assessed the potential precipitating factors. For the mouse studies, the possible implication of vaccination in the pathogenesis was explored. Results In our retrospective study, 51.22% of the 4,219 cases of myasthenia gravis (MG) were of the childhood onset type. The cohort study uncovered that the pathophysiology of CMG was mediated by immune deviation, rather than through gene mutations or virus infections. The administration of the live‐attenuated Japanese encephalitis vaccine (LA‐JEV), but not the inactivated vaccine or other vaccines, in mice induced serum acetylcholine receptor (AChR) antibody production, reduced the AChR density at the endplates, and decreased both muscle strength and response to repetitive nerve stimulation. We found a peptide (containing 7 amino acids) of LA‐JEV similar to the AChR‐α subunit, and immunization with a synthesized protein containing this peptide reproduced the MG‐like phenotype in mice. Interpretation Our results describe the immunological profile of CMG. Immunization with LA‐JEV induced an autoimmune reaction against the AChR through molecular mimicry. These findings might explain the higher occurrence rate of CMG in China, where children are routinely vaccinated with LA‐JEV, compared with that in countries, where this vaccination is not as common. Efforts should be made to optimize immunization strategies and reduce the risk for developing autoimmune disorders among children. Ann Neurol 2018;84:386–400
Collapse
Affiliation(s)
- Dan He
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Han Zhang
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Jun Xiao
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Xiaofan Zhang
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Minjie Xie
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Key Laboratory of Neurological Disease of Education Committee of ChinaWuhanHubeiChina
| | - Dengji Pan
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Minghuan Wang
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Xiang Luo
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Bitao Bu
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Min Zhang
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wei Wang
- Department of NeurologyTongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Key Laboratory of Neurological Disease of Education Committee of ChinaWuhanHubeiChina
| |
Collapse
|
6
|
Kimura K, Okada Y, Fujii C, Komatsu K, Takahashi R, Matsumoto S, Kondo T. Clinical characteristics of autoimmune disorders in the central nervous system associated with myasthenia gravis. J Neurol 2019; 266:2743-2751. [PMID: 31342158 DOI: 10.1007/s00415-019-09461-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023]
Abstract
Myasthenia gravis (MG) is occasionally associated with autoimmune diseases in the central nervous system (CNS), such as neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), Morvan syndrome, and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Here, we report five original cases associated with autoimmune disorders in the CNS among 42 patients with MG in a single tertiary hospital in Japan (11.9%). In four of these five cases, the second disease developed when the preceding disease was unstable. Accurate diagnosis of the newly developing disease may be difficult in such cases, because some neurological symptoms can be seen in both disorders. This implies the great importance of recognizing the possible co-occurrence of MG and disorders in the CNS. In addition, a comprehensive review of the literature revealed distinct clinical characteristics depending on the associated disease in the CNS, including thymic pathology and temporal relationship between MG and associated CNS disorders. Notably, NMOSD usually develops after the onset of MG and thymectomy, in clear contrast to MS. Thymoma is highly prevalent among patients with Morvan syndrome, in contract to cases with NMOSD and MS. The analysis of clinical characteristics, representing the first such investigation to the best of our knowledge, suggests different pathogeneses of these autoimmune diseases in the CNS, and provides significant implications for clinical practice.
Collapse
Affiliation(s)
- Kimitoshi Kimura
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
- Department of Immunology, National Center of Neurology and Psychiatry, National Institute of Neuroscience, 4-1-1 Ogawahigashi, Kodaira, 187-8502, Tokyo, Japan
| | - Yoichiro Okada
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, 570-8507, Osaka, Japan
| | - Chihiro Fujii
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kenichi Komatsu
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sadayuki Matsumoto
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Takayuki Kondo
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan.
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, 570-8507, Osaka, Japan.
| |
Collapse
|
7
|
Ducci RD, Lorenzoni PJ, Kay CSK, Werneck LC, Scola RH. Clinical follow-up of pregnancy in myasthenia gravis patients. Neuromuscul Disord 2017; 27:352-357. [PMID: 28256306 DOI: 10.1016/j.nmd.2017.01.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/20/2017] [Accepted: 01/27/2017] [Indexed: 02/05/2023]
Abstract
This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0.028) and lower myasthenia gravis composite (MGC) scores (p = 0.045) before pregnancy. The improvement group was associated with higher MGC scores (p = 0.012) before pregnancy. The no-change group was associated with longer duration of MG (p = 0.026) and normal RNS (p = 0.008) before pregnancy. The course of MG in the second pregnancy was different from that in the previous pregnancy in 65.3% of cases. Obstetric complications were reported in 20 pregnancies; the most common was preterm premature rupture of membranes (PPROM) (25.8%), and the most severe were abortion (11.4%) and fetal death (2.9%). Most of the patients delivered via caesarean section (66.7%). Spinal anesthesia was performed in 73.3%. Transient neonatal myasthenia gravis occurred in 12.9% of live-born infants, and no predictors were found. In conclusion, severity and duration of MG, RNS and treatment influence MG and pregnancy. Pregnant MG patients have greater rates of PPROM and caesarean delivery. Our data suggest that duration of MG, MGC and RNS before pregnancy may be useful in helping to predict the course of MG during pregnancy.
Collapse
Affiliation(s)
- Renata D Ducci
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil
| | - Paulo J Lorenzoni
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil
| | - Claudia S K Kay
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil
| | - Lineu C Werneck
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil
| | - Rosana H Scola
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil.
| |
Collapse
|
8
|
Huang HP, Pan H, Wang HF. "Warming yang and invigorating qi" acupuncture alters acetylcholine receptor expression in the neuromuscular junction of rats with experimental autoimmune myasthenia gravis. Neural Regen Res 2016; 11:465-8. [PMID: 27127487 PMCID: PMC4829013 DOI: 10.4103/1673-5374.179060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Myasthenia gravis is an autoimmune disorder in which antibodies have been shown to form against the nicotinic acetylcholine nicotinic postsynaptic receptors located at the neuromuscular junction. “Warming yang and invigorating qi” acupuncture treatment has been shown to reduce serum inflammatory cytokine expression and increase transforming growth factor beta expression in rats with experimental autoimmune myasthenia gravis. However, few studies have addressed the effects of this type of acupuncture on the acetylcholine receptors at the neuromuscular junction. Here, we used confocal laser scanning microscopy to examine the area and density of immunoreactivity for an antibody to the nicotinic acetylcholine receptor at the neuromuscular junction in the phrenic nerve of rats with experimental autoimmune myasthenia gravis following “warming yang and invigorating qi” acupuncture therapy. Needles were inserted at acupressure points Shousanli (LI10), Zusanli (ST36), Pishu (BL20), and Shenshu (BL23) once daily for 7 consecutive days. The treatment was repeated after 1 day of rest. We found that area and the integrated optical density of the immunoreactivity for the acetylcholine receptor at the neuromuscular junction of the phrenic nerve was significantly increased following acupuncture treatment. This outcome of the acupuncture therapy was similar to that of the cholinesterase inhibitor pyridostigmine bromide. These findings suggest that “warming yang and invigorating qi” acupuncture treatment increases acetylcholine receptor expression at the neuromuscular junction in a rat model of autoimmune myasthenia gravis.
Collapse
Affiliation(s)
- Hai-Peng Huang
- School of Acupuncture and Moxibustion, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Hong Pan
- Graduate School of Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Hong-Feng Wang
- Graduate School of Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| |
Collapse
|
9
|
Mourão AM, Barbosa LSM, Comini-Frota ER, Freitas DDS, Gomez RS, Burns TM, Lemos SMA, Teixeira AL. Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais. Rev Assoc Med Bras (1992) 2015; 61:156-60. [PMID: 26107366 DOI: 10.1590/1806-9282.61.02.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to determine the clinical profile of patients with myasthenia gravis (MG); followed at the Neuromuscular Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, and to compare it with other Brazilian case series. METHODS sociodemographic and clinical data were collected from patients, and a systematic literature review performed, focusing on national studies on the clinical profile of MG patients. RESULTS sixty nine patients were enrolled in the study. Fifty five (91%) subjects were female and the mean age (SD) was 37.6 (± 11.4) years. The mean disease duration was 14.1 years. Regarding treatment, prednisone was the most used strategy (64%), followed by the use of azathioprine (43%). There was no difference between thymectomized (42) and non-thymectomized (27) patients regarding disease severity and medication use. CONCLUSION clinical and socio-demographic features of this MG sample from a University-based clinic resemble those reported in other Brazilian series and in the international literature.
Collapse
Affiliation(s)
| | | | | | - Denise da Silva Freitas
- Neurology Service, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Santiago Gomez
- Neurology Service, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ted M Burns
- University of Virginia, Charlottesville, Virginia, USA
| | - Stela Maris Aguiar Lemos
- Department of Speech Pathology and Audiology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | |
Collapse
|
10
|
Murai H, Masuda M, Utsugisawa K, Nagane Y, Suzuki S, Imai T, Motomura M, Konno S, Kira JI. Clinical features and treatment status of adult myasthenia gravis in Japan. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cen3.12091] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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
| | - Masayuki Masuda
- Department of Neurology; Tokyo Medical University; Tokyo 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
- Department of Clinical Neuroscience and Neurology; Nagasaki University Hospital; Nagasaki Japan
| | - Shingo Konno
- Department of Neurology; Toho University Medical Center Ohashi Hospital; Tokyo Japan
| | - Jun-ichi Kira
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University Fukuoka Japan
| |
Collapse
|
11
|
Nemr NK, Simões-Zenari M, Ferreira TS, Fernandes HR, Mansur LL. Disfonia como principal queixa num quadro de miastenia grave: diagnóstico e fonoterapia. Codas 2013; 25:297-300. [DOI: 10.1590/s2317-17822013000300017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 02/19/2013] [Indexed: 11/22/2022] Open
Abstract
Miastenia grave é uma doença autoimune que se manifesta por fraqueza e fadiga muscular progressivas. São frequentes os sintomas oculares e bulbares, dentre eles, a disfonia. Este artigo relata um caso de disfonia, cuja avaliação fonoaudiológica contribuiu com o diagnóstico de miastenia grave e seu tratamento. A paciente em questão procurou o atendimento fonoaudiológico com diagnóstico otorrinolaringológico de presbifonia. A avaliação perceptivo-auditiva e acústica da voz identificou alterações em respiração, fonte glótica e filtro/ressonância. Como alguns dados obtidos com a anamnese e observados nas provas vocais não se relacionavam diretamente com a presença de presbifonia, houve a necessidade de discussão do caso com o médico, quando ambos concluíram a necessidade de encaminhar a paciente para avaliação neurológica. O neurologista consultado levantou a hipótese diagnóstica de miastenia grave e solicitou exames. A paciente seguiu em acompanhamento fonoaudiológico e medicamentoso. Na reavaliação vocal, ocorrida cerca de dois meses após o início do tratamento, foi constatada melhora na qualidade vocal, com grande impacto na qualidade de vida. Este trabalho evidencia a importância da avaliação fonoaudiológica detalhada e da participação do fonoaudiólogo na equipe interdisciplinar.
Collapse
|
12
|
Živković SA, Clemens PR, Lacomis D. Characteristics of late-onset myasthenia gravis. J Neurol 2012; 259:2167-71. [DOI: 10.1007/s00415-012-6478-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/04/2012] [Accepted: 03/05/2012] [Indexed: 12/27/2022]
|