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Lung 2021 May 13. Epub 2021 May 13.

Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.

Purpose: This study aimed to investigate the association between asthma and risk of myasthenia gravis (MG) using the method of systematic review and meta-analysis.

Methods: Potentially eligible studies were identified from Medline and EMBASE databases from inception to July 2020 using search strategy that comprised terms for "Asthma" and "Myasthenia Gravis". Eligible cohort study must consist of one cohort of individuals with asthma and another cohort of individuals without asthma. Read More

Eur J Case Rep Intern Med 2021 12;8(3):002375. Epub 2021 Mar 12.

University Hospital of Mohammed VI, Department of Internal Medicine, Marrakesh, Morocco.

Introduction: Myasthenia gravis is a rare autoimmune disease caused by autoantibodies directed against the synapses of the neuromuscular junction.

Patient And Methods: We report the case of a young patient with myasthenia gravis associated with Hodgkin's lymphoma.

Results: A 22-year-old patient presented with a 2-month history of severe weakness associated with muscle fatigability and intermittent ptosis without dysphonia or respiratory signs. Read More

Kyobu Geka 2021 Feb;74(2):139-141

Department of Cardiovascular Surgery, Otakanomori Hospital, Kashiwa, Japan.

The patient was a 76-year-old man with myasthenia gravis (MG). He suffered from a sudden back pain, and was diagnosed with Stanford type A acute aortic dissection. We performed emergency graft replacement of the ascending aorta under cardiopulmonary bypass with hypothermic circulatory arrest. Read More

Expert Rev Mol Diagn 2021 May 10. Epub 2021 May 10.

Autoimmunity Laboratory, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genova (GE), Italy.

: Myasthenia gravis (MG) is a prototypical autoimmune disease, characterized by pathogenic autoantibodies targeting structures of the neuromuscular junction. Radioimmunoprecipitation assays (RIPAs) represent the gold standard for their detection. However, new methods are emerging to complement, or overcome RIPAs, also with the perspective of eliminating the use of radioactive reagents. Read More

J Neurol 2021 May 10. Epub 2021 May 10.

Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Universitaetsstraße 84, 93051, Regensburg, Germany.

Myasthenic crisis (MC) is a life-threatening condition for patients with myasthenia gravis (MG). Muscle-specific kinase-antibodies (MuSK-ABs) are detected in ~ 6% of MG, but data on outcome of MuSK-MCs are still lacking. We made a subgroup analysis of patients who presented with MC with either acetylcholine-receptor-antibody positive MG (AchR-MG) or MuSK-MG between 2006 and 2015 in a retrospective German multicenter study. Read More

J Neurol Neurosurg Psychiatry 2021 May 7. Epub 2021 May 7.

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

J Neuroimmunol 2021 Apr 30;356:577588. Epub 2021 Apr 30.

University Hospital Würzburg, Department of Neurology, Josef-Schneider-Str. 11, 97080 Würzburg, Germany. Electronic address:

Autoantibodies against agrin and cortactin have been described in patients with myasthenia gravis. To further validate and characterize these autoantibodies, sera and/or plasma exchange material of 135 patients with myasthenia gravis were screened for anti-agrin or anti-cortactin autoantibodies. Autoantibodies against cortactin were detected in three patients and two controls and could be confirmed by cell-based assays using cortactin-transfected human embryonic kidney cells in both controls and one patient, but were not detectable in follow-up sera of the three patients. Read More

Muscle Nerve 2021 May 6. Epub 2021 May 6.

Department of Neurology, The University of North Carolina, Chapel Hill, NC.

Telemedicine may be particularly well-suited for myasthenia gravis (MG) due to the disorder's need for specialized care, its hallmark fluctuating muscle weakness and the potential for increased risk of virus exposure among patients with MG during the COVID-19 pandemic during in-person clinical visits. A disease-specific telemedicine physical examination to reflect myasthenic weakness does not currently exist. This paper outlines step-by-step guidance on the fundamentals of a telemedicine assessment for MG. Read More

MMWR Recomm Rep 2021 05 7;70(2):1-30. Epub 2021 May 7.

Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. Read More

Thorac Cancer 2021 May 6. Epub 2021 May 6.

Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, University of Tokushima Graduate School, Tokushima, Japan.

Background: Thymomas are the most common type of anterior mediastinal tumors. Calcification is sometimes observed in thymomas using computed tomography (CT), and it is more frequent in invasive thymomas than in noninvasive thymomas. However, the significance of calcification in thymomas remains unknown. Read More

Medicine (Baltimore) 2021 May;100(18):e25701

Department of Neurology, University of Missouri Health Care, Missouri.

Rationale: Myasthenia gravis (MG) patients are at increased risk of COVID-19 infection and its complications due to chronic immunosuppression. COVID-19 infection can also increase the risk of myasthenia exacerbation.

Patient Concerns: The patient presented with respiratory distress, fever and chills and was diagnosed with COVID-19 pneumonia. Read More

Neurology 2021 May 4. Epub 2021 May 4.

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California;

Objectives: To determine whether the available operative techniques for thymectomy in myasthenia gravis (MG) confer variable chances for achieving complete stable remission (CSR), we performed a meta-analysis of comparative studies of surgical approaches to thymectomy.

Methods: Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up.

Results: 12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. Read More

Vaccines (Basel) 2021 Apr 29;9(5). Epub 2021 Apr 29.

NIHR, Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust & Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK.

Background: Infectious diseases and vaccines can occasionally cause new-onset or flare of immune-mediated diseases (IMDs). The adjuvanticity of the available SARS-CoV-2 vaccines is based on either TLR-7/8 or TLR-9 agonism, which is distinct from previous vaccines and is a common pathogenic mechanism in IMDs.

Methods: We evaluated IMD flares or new disease onset within 28-days of SARS-CoV-2 vaccination at five large tertiary centres in countries with early vaccination adoption, three in Israel, one in UK, and one in USA. Read More

Front Oncol 2021 15;11:637185. Epub 2021 Apr 15.

Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.

Immune checkpoint inhibitors (ICIs) have considerably expanded the effective treatment options for malignant melanoma. ICIs revert tumor-associated immunosuppression and potentiate T-cell mediated tumor clearance. Immune-related neurologic adverse events (irNAEs) manifest in the central (CNS) or peripheral nervous system (PNS) and most frequently present as encephalitis or myasthenia gravis respectively. Read More

J Neuroophthalmol 2021 Apr 24. Epub 2021 Apr 24.

Department of Ophthalmology and Visual Sciences, University of Iowa Hospital and Clinics, University of Iowa Carver College of Medicine, Iowa City, Iowa Department of Ophthalmology Department of Neurology, New York- Presbyterian Hospital, Weill Cornell Medical College, New York City, New York Department of Ophthalmology, Massachusetts Eye & Ear Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Purpose: To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19) documented in the literature thus far.

Methods: The PubMed and Google Scholar databases were searched using the keywords: Neuro-Ophthalmology, COVID-19, SARS-CoV-2, coronavirus. A manual search through reference lists of relevant articles was also performed. Read More

Med Res Rev 2021 May 1. Epub 2021 May 1.

Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.

The K 1.3 voltage-gated potassium ion channel is involved in many physiological processes both at the plasma membrane and in the mitochondria, chiefly in the immune and nervous systems. Therapeutic targeting K 1. Read More

Neurology 2021 Apr 30. Epub 2021 Apr 30.

1 Neurology Department, Eginition Hospital, National and Kapodistrian University of Athens, Greece.

Front Neurol 2021 13;12:599744. Epub 2021 Apr 13.

Electromyography Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

This study aimed to analyze the clinical features of myasthenia gravis (MG) in combination with the afterdischarges and compare the characteristics of afterdischarges in MG with different serum antibodies. Ninety-two patients with MG were analyzed retrospectively. The afterdischarges were investigated using motor nerve conduction examination, F-wave examination, and repetitive nerve stimulation (RNS). Read More

J Neurosci Rural Pract 2021 Apr 13;12(2):410-411. Epub 2021 Jan 13.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

We report three cases of myasthenia gravis in whom the asymmetrical ptosis at presentation became more pronounced with the described bedside technique. Pronounced ptosis could be elicited by making the patient speak continuously for up to 2 minutes. Pauses for breathing and natural blinking were allowed. Read More

J Med Case Rep 2021 Apr 30;15(1):244. Epub 2021 Apr 30.

Department of Neurology, Changhua Christian Hospital, No. 135, Nanxiao Street, Changhua, 500, Taiwan.

Introduction: Pembrolizumab and other immune checkpoint inhibitors are the emerging treatment for selected, high-grade malignancies. However, a small number of patients are unable to tolerate its adverse effects, leading to discontinuation of this potentially life-changing therapy. In this study, we present a case of high-grade urothelial carcinoma patient, who experienced neurocomplications during the first pembrolizumab administration. Read More

J Clin Med 2021 Apr 16;10(8). Epub 2021 Apr 16.

Department of Neurology, Ibn-Sina Hospital, Sabah Health Area,, Kuwait City 13115, Kuwait.

The diagnosis of autoimmune Myasthenia Gravis (MG) remains clinical and rests on the history and physical findings of fatigable, fluctuating muscle weakness in a specific distribution. Ancillary bedside tests and laboratory methods help confirm the synaptic disorder, define its type and severity, classify MG according to the causative antibodies, and assess the effect of treatment objectively. We present an update on the tests used in the diagnosis and follow-up of MG and the suggested approach for their application. Read More

J Clin Med 2021 Apr 6;10(7). Epub 2021 Apr 6.

Department of Neurology, University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL 60637, USA.

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder which is characterized by presence of antibodies against acetylcholine receptors (AChRs) or other proteins of the postsynaptic membrane resulting in damage to postsynaptic membrane, decreased number of AChRs or blocking of the receptors by autoantibodies. A number of drugs such as immune checkpoint inhibitors, penicillamine, tyrosine kinase inhibitors and interferons may induce de novo MG by altering the immune homeostasis mechanisms which prevent emergence of autoimmune diseases such as MG. Other drugs, especially certain antibiotics, antiarrhythmics, anesthetics and neuromuscular blockers, have deleterious effects on neuromuscular transmission, resulting in increased weakness in MG or MG-like symptoms in patients who do not have MG, with the latter usually being under medical circumstances such as kidney failure. Read More

Int Immunopharmacol 2021 Apr 27;96:107511. Epub 2021 Apr 27.

Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, China; Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, China; Shandong Institute of Neuroimmunology, China. Electronic address:

Fingolimod (FTY720), a sphingosine 1-phosphate (S1P) receptor antagonist, possesses potent immunomodulatory activity via lymphocyte homing. The effects of FTY720 have been widely studied in various T-cell-mediated autoimmune diseases, while the immunomodulatory effects on experimental autoimmune myasthenia gravis (EAMG), a typical disease model for antibody-mediated autoimmunity, remain elusive. In the present study, FTY720 was administered to EAMG rats as prophylaxis. Read More

Acta Neurol Scand 2021 Apr 29. Epub 2021 Apr 29.

Neurology Department, National Institute Mongi Ben Hamida of Neurology, Tunis, Tunisia.

Objective: To describe presenting symptoms, clinical outcomes, and therapeutic management of concurrent Coronavirus disease 2019 (COVID-19) infections in patients with a pre-existing myasthenia gravis (MG).

Methods: We conducted a retrospective study in patients with preexisting MG presenting with concurrent COVID-19 between September 21st and November 4th, 2020 when attending the emergency department or routine neurology consultation at the National Institute Mongi Ben Hamida of Neurology of Tunis, Tunisia.

Results: Five patients were identified. Read More

Medicine (Baltimore) 2021 Apr;100(17):e25622

Hebei Key Laboratory of Myasthenia Gravis, Center of Treatment of Myasthenia Gravis Hebei Province, First Hospital of Shijiazhuang, Chang'an District, Shijiazhuang, Hebei Province, China.

Objectives: To evaluate the efficacy of double-filtration plasmapheresis (DFPP) treatment of myasthenia gravis (MG) through a systematic review and meta-analysis.

Methods: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang databases were searched for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on DFPP for MG from database establishment to June 2019. Two researchers independently screened the articles, extracted the data, and cross checked the results. Read More

Neurol India 2021 Mar-Apr;69(2):528-529

Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram, Kerala, India.

Neurol India 2021 Mar-Apr;69(2):419-425

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Background: Response to thymectomy in myasthenia gravis (MG) is influenced by various patient-, disease-, and therapy-related factors.

Methods: Retrospective analysis of 128 patients with MG who underwent maximal thymectomy over 15 years was done to identify the determinants of suboptimal clinical outcome.

Results: Among the 128 patients, 62 (48. Read More

Neurology 2021 Apr 26. Epub 2021 Apr 26.

Department of Neurology, Mayo Clinic, Rochester MN

Objective: To critically assess the clinical utility of striational antibodies (StrAbs) within paraneoplastic and myasthenia gravis serological evaluations.

Methods: All Mayo Clinic patients tested for StrAbs from January 1 2012-December 31 2018 utilizing Mayo's Unified Data Platform (UDP) were reviewed for neurological diagnosis and cancer.

Results: 38,502 unique paraneoplastic and 1,899 MG patients were tested. Read More

Neuromuscul Disord 2021 Feb 23. Epub 2021 Feb 23.

Departments of Neurology and 2Microbiology, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka 5731010, Japan.

The objective was to evaluate the long-term efficacy and safety of tacrolimus monotherapy in myasthenia gravis (MG) patients. Immunosuppressive drug-naïve MG patients were administered tacrolimus, followed by thymectomy in some of the cases according to the clinical guideline for MG. Additional aggressive immunosuppressive therapies were allowed if the patients without thymectomy did not achieve minimal manifestation (MM) or better status after 3 weeks of tacrolimus administration or in the thymectomized patients by 1-2 weeks after the operation (i. Read More

Curr Med Res Opin 2021 May 13:1-11. Epub 2021 May 13.

Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.

Objectives: This study examined the incidence and predictors of antimuscarinic medication use including non-selective antimuscarinics among older adults with dementia and overactive bladder (OAB).

Methods: The study used a new-user cohort design involving older adults (≥65 years) with dementia and OAB based on 2013-2015 Medicare data. Antimuscarinics included non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) medications. Read More