Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

2018 ◽  
Vol 68 (12) ◽  
pp. 2952-2954
Author(s):  
Andreea Teodorescu ◽  
Petru Ifteni ◽  
Paula Petric ◽  
Sebastian Toma ◽  
Adrian Baracan ◽  
...  
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Receptor Tyrosine Kinase ◽  
Skeletal Muscles ◽  
Early Recognition ◽  
Respiratory Muscles ◽  
Acetylcholinesterase Inhibitors ◽  
Psychotic Symptoms ◽  
Life Threatening ◽  
Myastenia Gravis

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease affecting the neuromuscular junction and causes weakness in the skeletal muscles. The acetylcholine receptor is usually attacked in skeletal muscles, but other components of neuromuscular junction, such as muscle-specific receptor tyrosine kinase, may be affected. MG can be life-threatening when the respiratory muscles are involved. The first symptom in about 2 out of 3 cases is the damage of the extrinsic eye muscles. The condition is treatable, so an early recognition is needed. Although there have been reports of associations between psychosis and myasthenia gravis it is unclear if psychotic symptoms in MG are an integral part of the various manifestations of this disease, or are due to another co-occurring distinct disorder. Sometimes psychotic episodes could disguise the simptoms of myastenia gravis, and delay the diagnosis.

scholarly journals A challenging case of hypercapnic respiratory failure during pregnancy

2020 ◽  
pp. 1753495X2094470
Author(s):  
B Vijayakumar ◽  
M Cao ◽  
L Mackillop ◽  
N Sarangmat ◽  
MI Leite ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Myasthenia Gravis ◽  
Early Recognition ◽  
Respiratory Muscles ◽  
Normal Pregnancy ◽  
Term Infant ◽  
Limb Weakness ◽  
Hypercapnic Respiratory Failure ◽  
Life Threatening ◽  
Muscle Specific Kinase

We describe a 40-year-old female who presented with progressive breathlessness and hypercapnic respiratory failure during pregnancy secondary to undiagnosed muscle-specific kinase myasthenia gravis. Her presentation was progressive and protracted, having over five contacts with healthcare professionals over nine months, many of these predating her pregnancy. Her atypical presentation for myasthenia with minimal limb weakness led to consideration of other causes of hypercapnic respiratory failure. Once diagnosed, she was treated with intravenous immunoglobulin and non-invasive ventilation. She gave birth to a pre-term infant by planned caesarean section. Her insidious presentation and the progressive nature of her breathlessness were unusual and our report highlights the predominant involvement of respiratory muscles in muscle-specific kinase myasthenia. Her pregnancy may have further delayed her diagnosis due the attribution of some symptoms to normal pregnancy. Early recognition and treatment of myasthenia gravis are important to prevent life-threatening complications.

scholarly journals Pathogenesis of myasthenia gravis: update on disease types, models, and mechanisms

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1513 ◽  
Author(s):  
William D. Phillips ◽  
Angela Vincent
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Respiratory Muscles ◽  
Postsynaptic Membrane ◽  
Synaptic Function ◽  
Density Lipoprotein Receptor ◽  
Synapse Maintenance ◽  
Muscle Groups

Myasthenia gravis is an autoimmune disease of the neuromuscular junction (NMJ) caused by antibodies that attack components of the postsynaptic membrane, impair neuromuscular transmission, and lead to weakness and fatigue of skeletal muscle. This can be generalised or localised to certain muscle groups, and involvement of the bulbar and respiratory muscles can be life threatening. The pathogenesis of myasthenia gravis depends upon the target and isotype of the autoantibodies. Most cases are caused by immunoglobulin (Ig)G1 and IgG3 antibodies to the acetylcholine receptor (AChR). They produce complement-mediated damage and increase the rate of AChR turnover, both mechanisms causing loss of AChR from the postsynaptic membrane. The thymus gland is involved in many patients, and there are experimental and genetic approaches to understand the failure of immune tolerance to the AChR. In a proportion of those patients without AChR antibodies, antibodies to muscle-specific kinase (MuSK), or related proteins such as agrin and low-density lipoprotein receptor-related protein 4 (LRP4), are present. MuSK antibodies are predominantly IgG4 and cause disassembly of the neuromuscular junction by disrupting the physiological function of MuSK in synapse maintenance and adaptation. Here we discuss how knowledge of neuromuscular junction structure and function has fed into understanding the mechanisms of AChR and MuSK antibodies. Myasthenia gravis remains a paradigm for autoantibody-mediated conditions and these observations show how much there is still to learn about synaptic function and pathological mechanisms.

scholarly journals What is optimal in patients with myasthenic crisis: Invasive or non-invasive ventilation?

2014 ◽  
Vol 01 (02) ◽  
pp. 116-120
Author(s):  
Hemant Bhagat ◽  
Vinod Grover ◽  
Kiran Jangra
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Respiratory Muscles ◽  
Myasthenic Crisis ◽  
Invasive Ventilation ◽  
Immune Disorder ◽  
Non Invasive ◽  
Advanced Form ◽  
Non Invasive Ventilation

AbstractMyasthenia gravis is an immune disorder involving the neuromuscular junction. The consequent weakness of respiratory muscles leads to variable disorders of ventilation in patients with myasthenia gravis. This article reviews the options of invasive and non-invasive ventilation in patients with advanced form of the disease.

scholarly journals Simultaneous Presence of Acetylcholine Receptor and Muscle Specific Tyrosine Kinase Antibodies in Myasthenia Gravis

2019 ◽  
Vol 4 (4) ◽  
pp. 128-130
Author(s):  
Maryam Poursadeghfard ◽  
Sara Azhdari
Keyword(s):  
Neuromuscular Junction ◽  
Tyrosine Kinase ◽  
Myasthenia Gravis ◽  
Acetylcholine Receptor ◽  
Receptor Tyrosine Kinase ◽  
Good Condition ◽  
Autoimmune Disorder ◽  
Simultaneous Presence ◽  
Specific Receptor ◽  
Progressive Course

Myasthenia gravis (MG) is known as an autoimmune disorder which affects transmission in neuromuscular junction. The serologic tests used for diagnosis include acetylcholine receptor and muscle specific receptor tyrosine kinase antibodies. Studies often have reported that patients with formal antibody are negative for the latter one. However, very limited studies have reported positive anti-muscle specific receptor tyrosine kinase antibody in a small percentage of patients with acetylcholine receptor antibody. Here, we reported a young woman who was diagnosed with MG and had a rapid and progressive course of the disease. She was seropositive for both acetylcholine receptor and muscle-specific receptor tyrosine kinase antibodies simultaneously. However, she discharged from the hospital with good condition after treatment.

scholarly journals Myasthenia gravis: A rare presentation

2016 ◽  
Vol 7 (6) ◽  
pp. 100-102
Author(s):  
Sandeep Lahiry ◽  
Dipak Bhowmik
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Skeletal Muscles ◽  
Autoimmune Disorder ◽  
Medical Sciences ◽  
Rare Presentation ◽  
Ache Inhibitors ◽  
Postsynaptic Receptors

Myasthenia gravis (MG) is a relatively rare autoimmune disorder in which antibodies form against acetylcholine (Ach) nicotinic postsynaptic receptors at the neuromuscular junction of skeletal muscles. The usual initial complaint is a muscle weakness but can also present as respiratory failure, as in our case. MG is treated with medications such as Acetylcholine-esterase (AChE) inhibitors or immunosuppresants and, in selected cases, thymectomy.Here, we present a case of 32 year old women with MG, who presented with an unexplained respiratory failure. She was stabilized with mechanical ventilation and subsequently treated with immunoglobins and thymectomy.Asian Journal of Medical Sciences Vol.7(5) 2016 100-102

The Initial Prodrome in Psychosis: Descriptive and Qualitative Aspects

1996 ◽  
Vol 30 (5) ◽  
pp. 587-599 ◽  
Author(s):  
Alison R. Yung ◽  
Patrick D. McGorry
Keyword(s):  
Early Recognition ◽  
Recovery Phase ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Consecutive Series ◽  
Episode Psychosis ◽  
Wide Variability ◽  
Life Threatening

Objective: This study aimed to describe in detail, using a retrospective approach, the prodromal symptoms in first-episode psychosis patients. This initial prodrome, the period of disturbance preceding a first psychotic episode, is potentially important for early intervention, identification of biological markers, and understanding the process of becoming psychotic. Method: A consecutive series of 21 first-episode patients was recruited from the Early Psychosis Prevention and Intervention Centre, a specialised service for young people aged between 16 and 30 with first-episode psychosis. Subjects were interviewed in the recovery phase after the acute episode, about the period leading up to the psychosis, using a combination of unstructured and semi-structured techniques. Results: A wide variability of phenomena and sequence patterns was found, with symptoms being a mixture of attenuated psychotic symptoms, neurotic and mood-related symptoms, and behavioural changes. Symptoms were often disabling and some, such as suicidal thoughts, potentially life-threatening. Conclusions: The findings highlight the loss of information that has resulted from disregarding early phenomenological studies of the psychotic prodrome and instead focussing on behavioural features. The ground work has been laid for the development of better methodologies for assessing and measuring first psychotic prodromes with increased emphasis on experiential phenomena. This has the potential to lead to the early recognition and more accurate prediction of subsequent psychosis, as well as a deeper understanding of the neurobiology of the onset of psychotic disorder.

scholarly journals Prevention and management of major complications in percutaneous endoscopic gastrostomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000628
Author(s):  
Kurt Boeykens ◽  
Ivo Duysburgh
Keyword(s):  
Clinical Practice ◽  
Abdominal Wall ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Early Recognition ◽  
Endoscopic Technique ◽  
Abdominal Wound ◽  
Review Of The Literature ◽  
Endoscopic Gastrostomy ◽  
Major Complications ◽  
Life Threatening

BackgroundPercutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only few major complications. Nevertheless these complicationscan be sometimes life-threatening or generate serious morbidity.MethodAnarrative review of the literature of major complications in percutaneousendoscopic gastrostomy.ResultsThis review was written from a clinical viewpoint focussing on prevention andmanagement of major complications and documentedscientific evidence with real cases from more than 20 years of clinical practice.ConclusionsMajorcomplications are rare but prevention, early recognition and popper management areimportant.

scholarly journals A case of amniotic fluid embolism successfully treated by multidisciplinary treatment

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Yuki Kinishi ◽  
Chiyo Ootaki ◽  
Takeshi Iritakenishi ◽  
Yuji Fujino
Keyword(s):  
Amniotic Fluid ◽  
Early Recognition ◽  
Multidisciplinary Treatment ◽  
Balloon Catheter ◽  
Amniotic Fluid Embolism ◽  
Pathological Examination ◽  
Total Blood ◽  
Occlusion Balloon ◽  
Life Threatening ◽  
Labor Epidural

Abstract Background Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. Because the maternal mortality associated with AFE is very high, early recognition and prompt treatment are important for improving the prognosis. We report a case of amniotic fluid embolism successfully treated by multidisciplinary treatment. Case presentation A 39-year-old woman with fetal congenital heart anomaly and polyhydramnios was scheduled for induction of delivery at 37 weeks of gestation with labor epidural analgesia. Uncontrollable bleeding occurred 30 min after vaginal delivery. Based on the clinical diagnosis of AFE, massive blood transfusion, insertion of an aortic occlusion balloon catheter, and hysterectomy was performed. Total blood loss was 12,000 mL. The diagnosis of AFE was confirmed by pathological examination. She was discharged with no complications. Conclusion We report a case of AFE who were rescued by prompt diagnosis and treatment.

scholarly journals Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

2020 ◽  
Vol 15 (06) ◽  
pp. 269-275
Author(s):  
Kaila Lessner ◽  
Conrad Krawiec
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Early Recognition ◽  
Spotted Fever ◽  
Pediatric Intensive Care ◽  
Rocky Mountain ◽  
Rocky Mountain Spotted Fever ◽  
Life Threatening ◽  
Human Ehrlichiosis

AbstractWhen unrecognized and antibiotic delay occurs, Lyme disease, Rocky Mountain–spotted fever, babesiosis, and human ehrlichiosis and anaplasmosis can result in multiorgan system dysfunction and potentially death. This review focuses on the early recognition, evaluation, and stabilization of the rare life-threatening sequelae seen in tick-borne illnesses that require admission in the pediatric intensive care unit.

scholarly journals Presynaptic Paraneoplastic Disorders of the Neuromuscular Junction: An Update

2021 ◽  
Vol 11 (8) ◽  
pp. 1035
Author(s):  
Maria Pia Giannoccaro ◽  
Patrizia Avoni ◽  
Rocco Liguori
Keyword(s):  
Potassium Channels ◽  
Neuromuscular Junction ◽  
Calcium Channels ◽  
Myasthenia Gravis ◽  
Neuromuscular Transmission ◽  
Voltage Gated ◽  
Voltage Gated Calcium Channels ◽  
Immune Mediated ◽  
Recent Developments ◽  
Myasthenic Syndrome

The neuromuscular junction (NMJ) is the target of a variety of immune-mediated disorders, usually classified as presynaptic and postsynaptic, according to the site of the antigenic target and consequently of the neuromuscular transmission alteration. Although less common than the classical autoimmune postsynaptic myasthenia gravis, presynaptic disorders are important to recognize due to the frequent association with cancer. Lambert Eaton myasthenic syndrome is due to a presynaptic failure to release acetylcholine, caused by antibodies to the presynaptic voltage-gated calcium channels. Acquired neuromyotonia is a condition characterized by nerve hyperexcitability often due to the presence of antibodies against proteins associated with voltage-gated potassium channels. This review will focus on the recent developments in the autoimmune presynaptic disorders of the NMJ.

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