Low Fluctuation of Symptoms May Delay Diagnosis of Myasthenia Gravis: A Case Series

Background: Distal/asymmetric presentations of myasthenia gravis (MG) are uncommon and occur in 3-7% of patients with MG. This pattern of weakness is often not recognized as a manifestation of MG, leading to inappropriate investigations, delayed diagnosis and potentially missed opportunities for treatment. Our knowledge about this atypical presentation is limited to small case series and individual case reports. This study therefore aims to expand our understanding by describing the clinical course, diagnosis and treatment of a larger series of patients with this presentation. Methods: We conducted a retrospective chart review of patients with definite MG (either acetylcholine receptor [AChR] or MuSK antibody positive or clear evidence of postsynaptic neuromuscular junction dysfunction on electrodiagnostic studies), who attended the MG Clinic in London. Details of the clinical course, electrodiagnostic studies, antibody testing and response to treatment are reported. Results: 5.9% (54/921) of patients with definite MG had distal/asymmetric limb involvement, 56% at onset and 4% developing more than 10 years later. Males predominated (2:1). Finger extensors were most affected. 83% were AChR antibody positive. 7% had thymomas. On repetitive nerve stimulation most patients showed the most significant decrement distally on the more affected side. Almost all patients improved with treatment. Conclusions: This study expands our understanding of distal/asymmetric presentations of MG.

Download Full-text

“Mummy, my eyelids are heavy”: A case series of juvenile myasthenia gravis

European Journal of Ophthalmology ◽

10.1177/1120672119867605 ◽

2019 ◽

pp. 112067211986760

Author(s):

Logeswari Krishna ◽

Nor Fadzillah Abdul Jalil ◽

Pooi Wah Lott ◽

Sujaya Singh ◽

May May Choo

Keyword(s):

Myasthenia Gravis ◽

Case Series ◽

Tertiary Centre ◽

Ocular Symptoms ◽

Ocular Myasthenia Gravis ◽

Life Threatening ◽

Receptor Antibodies ◽

Juvenile Myasthenia Gravis ◽

Anti Acetylcholine ◽

Second Twin

Purpose: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation. Method: A case series. Results: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis. Conclusion: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

Download Full-text

Treatment of refractory myasthenia gravis by double‐filtration plasmapheresis and rituximab: A case series of nine patients and literature review

Journal of Clinical Apheresis ◽

10.1002/jca.21868 ◽

2020 ◽

Author(s):

Hamza N. Bennani ◽

Emmeline Lagrange ◽

Johan Noble ◽

Paolo Malvezzi ◽

Lionel Motte ◽

...

Keyword(s):

Literature Review ◽

Myasthenia Gravis ◽

Case Series ◽

Double Filtration Plasmapheresis ◽

Double Filtration

Download Full-text

Myasthenia gravis exacerbation after melatonin administration: case series from a tertiary referral centre

BMC Neurology ◽

10.1186/s12883-020-01975-y ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Velina Nedkova-Hristova ◽

Valentina Vélez-Santamaría ◽

Carlos Casasnovas

Keyword(s):

Immune System ◽

Myasthenia Gravis ◽

Clinical Improvement ◽

Case Series ◽

Adaptive Immune System ◽

Intravenous Immunoglobulins ◽

Postsynaptic Membrane ◽

Referral Centre ◽

Tertiary Referral Centre ◽

Melatonin Administration

Abstract Background Myasthenia gravis is an autoimmune disease mediated by antibodies against proteins associated with the postsynaptic membrane of the neuromuscular junction. Several drugs may trigger an exacerbation of the disease. Melatonin supplements are widely used for the treatment of insomnia as they are well tolerated with few side effects. The role of melatonin in the immune system and its effects in autoimmune disorders remain uncertain. Case presentation We identified three patients in our referral centre from 2014 to 2019 who presented a worsening within days or weeks of starting melatonin. Two of them stopped the treatment without clinical improvement in the next week. Increasing dose of corticosteroids did not lead to clinical improvement in the next month and one of the patients was finally administered intravenous immunoglobulins. Conclusion Melatonin may trigger exacerbations of myasthenia gravis, probably due to an upregulation of the adaptive immune system and an interaction with the corticosteroids and other immunosuppressant treatments. We consider that melatonin should be administered with caution in these patients.

Download Full-text

Coincident parkinsonism and myasthenia gravis: A case series

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2021.06.016 ◽

2021 ◽

Author(s):

Jumana T. Alshaikh ◽

Kelly Mills

Keyword(s):

Myasthenia Gravis ◽

Case Series

Download Full-text

A Case Series of Patients With Autoimmune Myasthenia Gravis in Association With Invasive Thymoma

Journal of Clinical Neuromuscular Disease ◽

10.1097/cnd.0000000000000101 ◽

2016 ◽

Vol 17 (3) ◽

pp. 129-134 ◽

Cited By ~ 1

Author(s):

Pamela McCombe ◽

Meenakshi Raj ◽

Robert Henderson ◽

Stefan Blum

Keyword(s):

Myasthenia Gravis ◽

Case Series ◽

Invasive Thymoma ◽

Autoimmune Myasthenia

Download Full-text

COVID-19 Vaccination in Patients with Myasthenia Gravis: A Single-Center Case Series

Vaccines ◽

10.3390/vaccines9101112 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1112

Author(s):

Zhe Ruan ◽

Yonglan Tang ◽

Chunhong Li ◽

Chao Sun ◽

Ying Zhu ◽

...

Keyword(s):

Myasthenia Gravis ◽

Acetylcholine Receptors ◽

Subunit Vaccine ◽

Clinical Characteristics ◽

Case Series ◽

Onset Age ◽

Single Center ◽

Inactivated Vaccines ◽

Main Observation ◽

The Mean

In this study, we report the safety of coronavirus disease 2019 (COVID-19) vaccine in patients with myasthenia gravis (MG). Patients who were vaccinated against COVID-19 were included. Demographics, clinical characteristics, medications, and vaccination information were collected. The main observation outcome is the worsening of MG symptoms within 4 weeks following COVID-19 vaccination. A total of 22 patients with MG vaccinated for COVID-19 were included. Ten (45.5%) patients had ocular MG (OMG), and 12 (55.5%) patients had generalized MG (GMG). Six (27.3%) patients were female, and the mean (SD) onset age was 45.4 (11.8) years. Nineteen (86.4%) patients were seropositive for acetylcholine receptors (AChR) antibody. Seven (31.8%) patients underwent thymectomy, and four of them confirmed thymoma pathologically. Twenty-one patients were administrated with inactivated vaccines, and the remaining one was administrated with recombinant subunit vaccine. Twenty (90.9%) patients did not present MG symptom worsening within 4 weeks of COVID-19 vaccination, and two (9.1%) patients reported slight symptom worsening but resolved quickly within a few days. Our findings suggest inactivated COVID-19 vaccines might be safe in MG patients with Myasthenia Gravis Foundation of America (MGFA) classification I to II, supporting the recommendation to promote vaccination for MG patients during the still expanding COVID-19 pandemic.

Download Full-text