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Case Rep Neurol 2020 Jan-Apr;12(1):114-120. Epub 2020 Mar 17.

Department of Neurology, Fukuoka University School of Medicine, Fukuoka, Japan.

A 31-year-old woman presented with a nasal voice, dysarthria, and upper limb weakness during her first pregnancy. Soon after delivery of her first baby, her symptoms disappeared. At the age of 34 years, during her second pregnancy, her nasal voice re-appeared. Read More

Continuum (Minneap Minn) 2019 Dec;25(6):1767-1784

Purpose Of Review: Myasthenia gravis (MG) is an autoimmune neuromuscular disease that causes fluctuating weakness in ocular, bulbar, and limb muscles and can, in 15% of cases, cause myasthenic crisis, a neurologic emergency characterized by respiratory failure. Although infrequent, MG needs to be promptly recognized and treated because the potential for improvement and remission is very high. The diagnosis of MG can be challenging and delayed because of the fluctuating nature of muscle weakness and the overlap of signs and symptoms with other neuromuscular diseases. Read More

Transfus Apher Sci 2019 Oct 5;58(5):652-658. Epub 2019 Sep 5.

Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Italy; Internal Medicine, San Bortolo Hospital, Vicenza, Italy.

Introduction: Therapeutic apheresis (TA) represents a treatment option for pre-existing conditions or diseases occurring during gestation. Although pregnancy is not a contraindication per se, due to the lack of evidence-based guidelines and presumed risk of maternal/fetal adverse events there is a general resistance to its application.

Material And Methods: Between January 2005 and August 2017, at the Apheresis Unit of the University Hospital of Padua 936 TA procedures were performed during 57 pregnancies in 48 patients: 813 Plasma Exchange sessions, 119 Immunoadsorptions, 4 Red Blood Cell exchanges. Read More

Neurology 2019 10 6;93(15):668-672. Epub 2019 Sep 6.

From the Department of Neurology, School of Medicine, and Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco.

Many neurologic diseases disproportionately affect women, particularly during their reproductive years. For many of these diseases, monoclonal antibodies (mAbs) are becoming widely available as a treatment option, for example, in migraine, multiple sclerosis, and myasthenia gravis. Yet, despite how common pregnancy is (latest estimates suggest that 86% of US women ages 40-44 have given birth), there is a paucity of research on the safety of prescription medications, including mAbs, during the peripartum period. Read More

BMJ Open 2019 07 9;9(7):e024505. Epub 2019 Jul 9.

Obstetric and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Objectives: To explore the current status to which Canadian obstetrics and gynaecology (Ob-Gyn) programmes teach residents about pregnancy in patients with physical disabilities, and to assess the level of interested in providing formal education sessions in this field. This study also assesses the residents' perception of their knowledge and their comfort level caring for women with physical disabilities (WWPD), which will further determine the need for incorporation of this topic into the residency curriculum.

Design: Cross-sectional survey. Read More

Ir J Med Sci 2019 Nov 9;188(4):1261-1267. Epub 2019 May 9.

Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey.

Background And Aim: To share our experience with the management of pregnancies in women with myasthenia gravis (MG) in a tertiary center.

Methods: The study retrospectively evaluated 27 pregnancies in 12 patients. The pregnancies were divided into 3 groups on the basis of the clinical course of MG during pregnancy: improvement (n = 7), disease-stable (n = 9), and deterioration (n = 11). Read More

Am J Case Rep 2019 Apr 29;20:620-627. Epub 2019 Apr 29.

Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan.

BACKGROUND Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. Read More

J Obstet Gynaecol Res 2019 May 25;45(5):974-980. Epub 2019 Feb 25.

Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.

Aim: Pregnancy with myasthenia gravis (MG) is known to be associated with an increased cesarean section rate, presumably due to maternal fatigue during labor. Although epidural labor analgesia (ELA) appears to be a good option for circumventing maternal fatigue, a protocol for managing MG deliveries has not been established. This study, based on a review of our case series, aimed to evaluate the validity of our management protocol for maternal MG, in which ELA is used depending on MG severity. Read More

Indian J Pharmacol 2018 Nov-Dec;50(6):302-308

Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

The management of myasthenia gravis (MG) during pregnancy requires special skills as both diseases as well as its treatment can have deleterious effects on mother and fetus. MG often affects women in second and third decades of life during the childbearing age. Exacerbations of MG are likely to occur during the first trimester and postpartum period. Read More

Curr Opin Obstet Gynecol 2019 04;31(2):97-109

Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.

Purpose Of Review: To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother-infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed.

Recent Findings: Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Read More

Neurol Clin 2019 02;37(1):85-102

Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USA. Electronic address:

The physiologic changes that accompany pregnancy can have important implications for neuro-ophthalmic disease. This article discusses pregnancy-related considerations for meningioma, pituitary disorders, demyelinating disease, myasthenia gravis, thyroid eye disease, idiopathic intracranial hypertension, cerebral venous sinus thrombosis, stroke, migraine, and cranial neuropathies. The article also details the potential neuro-ophthalmic complications of preeclampsia and eclampsia and reviews the use of common diagnostic studies during pregnancy. Read More

Neurol Clin 2019 02;37(1):113-120

Women's Neurology, University of Pittsburgh Medical Center, 3471 Fifth Avenue Suite 810, Pittsburgh, PA 15213, USA. Electronic address:

Myasthenia gravis is an autoimmune disorder characterized by fluctuating weakness of extraocular and proximal limb muscles. It occurs in 1 in 5000 in the overall population and is 2 times more common in women than men. The onset in women is most common in the third decade, and risk of severe exacerbation occurs most frequently in the year after presentation. Read More

Undersea Hyperb Med 2018 Jul-Aug;45(4):453-456

University of Virginia School of Medicine, Charlottesville, Virginia U.S.

Background: The fetus is uniquely susceptible to carbon monoxide (CO) exposure. We present a case of severe unintentional CO poisoning in the first trimester of pregnancy.

Case: A 23-year-old G5P2022 female at 11 weeks' gestational age sat in a car with the engine idling. Read More

J Community Hosp Intern Med Perspect 2018 22;8(4):230-232. Epub 2018 Jun 22.

Department of Critical Care/Pulmonary Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA.

Myasthenia Gravis (MG) is a disorder of the neuromuscular junction (NMJ) that manifests as fluctuating fatiguable weakness of the muscles. There are many factors that can exacerbate myasthenia symptoms including a variety medications and drugs, systemic illness, and pregnancy. A number of medications have been implicated in exacerbating MG symptoms, including aminoglycosides. Read More

Eur J Neurol 2018 12 14;25(12):1402-1409. Epub 2018 Sep 14.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Females with myasthenia gravis (MG) worry about their disease having negative consequences for their children. Autoimmune disease mechanisms, treatment and heredity could all have an impact on the child. This is a subject review where Web of Science was searched for relevant keywords and combinations. Read More

Aesthet Surg J 2018 Oct;38(11):NP156-NP164

William Beaumont Hospital, Oakland University William Beaumont School of Medicine in Royal Oak, Michigan.

Background: In some upper eyelid blepharoplasties, maximal skin removal may not result in desired outcomes; raising crease height can therefore be considered. Currently, there is no method to determine the amount of skin to be excised and/or crease elevation required to achieve a specific outcome.

Objective: This study extrapolated an equation to determine amount of skin excision and/or lid crease elevation needed to achieve a specific eyelid margin to fold distance (MFD). Read More

Br J Hosp Med (Lond) 2018 Jul;79(7):410-411

Consultant Anaesthetist, Department of Anaesthesia, Royal Bolton Hospital, Bolton.

J Neuromuscul Dis 2018 ;5(2):261-264

Department of Neurology, University Medical Centre of Groningen, The Netherlands.

A patient with autoimmune myasthenia gravis and a clinical and serological follow-up of 13 years is described. In this unique case, serum samples were available up to two years before the clinical onset of the myasthenia gravis and showed gradual increase of acetylcholine receptor antibodies, starting two years before onset of the clinical symptoms. Read More

Arthritis Rheumatol 2018 11;70(11):1796-1800

McGill University Health Centre, Montreal, Quebec, Canada.

Objective: Several autoimmune diseases have familial aggregation and, possibly, common genetic predispositions. In a large population-based study, we evaluated whether children born to mothers with systemic lupus erythematosus (SLE) have an increased risk of rheumatic and nonrheumatic autoimmune diseases versus children born to mothers without SLE.

Methods: Using the Offspring of SLE Mothers Registry, we identified children born live to SLE mothers and their matched controls, and ascertained autoimmune diseases based on ≥1 hospitalization or ≥2 physician visits with a relevant diagnostic code. Read More

Neurol Clin 2018 05;36(2):355-365

University of Rochester Medical Center, University of Rochester, 601 Elmwood Avenue, PO Box 673, Rochester, NY 14642, USA.

Myasthenia gravis presents a risk factor for pregnancy and delivery, and can affect the newborn. In return, pregnancy can affect the course of myasthenia and worsen the disease during pregnancy requiring treatment modifications. Treatment optimization and drug safety should be addressed before conception. Read More

Neuromuscul Disord 2018 03 13;28(3):278-282. Epub 2017 Dec 13.

Department of Neurology, Hospital Prof. Doutor Fernando Fonseca, EPE, IC 19, 2720-276 Amadora, Portugal.

DOK7 congenital myasthenic syndrome (DOK7-CMS) generally presents early in life and is treated with salbutamol or ephedrine. This report describes an atypical case of a 39-year-old woman who presented with proximal upper limb weakness in the third trimester of pregnancy and was initially diagnosed with seronegative myasthenia gravis. Dramatic clinical worsening under pyridostigmine and further inefficacy of steroids, intravenous human immunoglobulin (IVIG) and plasma exchange (PLEX) led to the presumptive diagnosis of a CMS. Read More

Ann N Y Acad Sci 2018 01;1412(1):95-101

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

A task force of the Myasthenia Gravis Foundation of America recently published a formal consensus statement intended to be a treatment guide for clinicians caring for myasthenia gravis (MG) patients worldwide. Its development was stimulated by the fact that there is generally no accepted standard of care for MG, and no one treatment is best for all MG patients. Also, there are few randomized trials of treatments in current use, and the generalizability of the few trials that have been successful may be difficult. Read More

J Perioper Pract 2017 Jan;27(1-2):27-28

Royal Victoria Hospital, Belfast, UK.

RS is a 28-year old lady who presented in her first pregnancy to the High-Risk Obstetric Clinic for review in view of her medical history of myasthenia gravis. She was diagnosed with myasthenia gravis (MG) as a teenager, and underwent thymectomy soon after diagnosis. At the time of presentation to the clinic, RS was taking pyridostigmine and azathioprine for her MG. Read More

Neuromuscul Disord 2018 02 28;28(2):150-153. Epub 2017 Nov 28.

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom.

Muscle specific kinase (MuSK) myasthenia gravis (MG, MuSK-MG) is a rare subgroup of MG affecting mainly women during childbearing years. We investigated the influence of pregnancy in the course of MuSK-MG and pregnancy outcomes in females with MuSK-MG. A multicentre cohort of 17 women with MuSK-MG was studied retrospectively; 13 of them with ≥1 pregnancy. Read More

Semin Neurol 2017 12 21;37(6):643-652. Epub 2017 Dec 21.

Department of Neurology, Neuromuscular Division, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.

Neuromuscular disorders may present and progress differently in women than in men. During pregnancy, medication adjustment, hormonal effects, and other alterations in physiology may influence the manifestation of a variety of neuromuscular disorders. The expression of existing conditions may change; previously asymptomatic conditions may be unmasked, or entirely new conditions may develop. Read More

J Neurol Sci 2017 Dec 6;383:118-122. Epub 2017 Nov 6.

Myasthenia Gravis Unit, Neonatology Department, Vall d'Hebron University Hospital, Barcelona, Spain.

Introduction: Pregnant women with myasthenia gravis (MG) are at increased risk of complications and adverse outcomes, including the teratogenic effects of many drugs used to treat MG women of childbearing age. The effectiveness of intravenous immunoglobulins (IVIg) on other autoimmune mediated diseases has been extensively reported in recent years, although little is known about the role of IVIg in the treatment of MG during pregnancy. We designed this study to determine the effectiveness of IVIg as monotherapy during pregnancy for women with MG. Read More

Duodecim 2017;133(11):1053-62

Myasthenia gravis (MG) is the most common neuromuscular transmission disorder, causing weakness of skeletal muscles on exertion. The course of the disease is highly variable, symptoms and signs may change rapidly due to infection or pregnancy. MG is classified using serological, electrophysiological and pharmaceutical tools. Read More

Sci Rep 2017 10 31;7(1):14426. Epub 2017 Oct 31.

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.

We report here the sequence and functional characterization of a recombinantly expressed autoantibody (mAb 131) previously isolated from a myasthenia gravis patient by immortalization of thymic B cells using Epstein-Barr virus and TLR9 activation. The antibody is characterized by a high degree of somatic mutations as well as a 6 amino acid insertion within the VHCDR2. The recombinant mAb 131 is specific for the γ-subunit of the fetal AChR to which it bound with sub-nanomolar apparent affinity, and detected the presence of fetal AChR on a number of rhabdomyosarcoma cell lines. Read More

Sultan Qaboos Univ Med J 2017 Aug 10;17(3):e259-e267. Epub 2017 Oct 10.

Department of Neurology, King Fahd Hospital, University of Dammam, Khobar, Saudi Arabia.

(MG) is an autoimmune neuromuscular disorder which is twice as common among women, often presenting in the second and third decades of life. Typically, the first trimester of pregnancy and first month postpartum are considered high-risk periods for MG exacerbations. During pregnancy, treatment for MG is usually individualised, thus improving its management. Read More

Intern Med 2017 Dec 16;56(24):3361-3364. Epub 2017 Oct 16.

Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Japan.

We herein report the case of a 46-year-old pregnant woman with anti-muscle specific kinase (MuSK) antibody-positive myasthenia gravis (MG) who showed pregnancy-induced hypertension and developed respiratory failure at 30 weeks and 5 days of pregnancy, and who underwent an emergency caesarean section (CS). Her MG symptoms gradually improved in the subsequent weeks. The premature baby with positive MuSK antibodies was successfully delivered, but the male baby required temporary artificial ventilation. Read More

J Matern Fetal Neonatal Med 2018 Jul 18;31(13):1798-1806. Epub 2017 Jun 18.

a Fetal Medicine Research Institute , King's College Hospital , London , UK.

Maternal autoantibodies can cross the placenta and cause fetal damage. This article summarizes the development and management of fetal thyroid goiter in response to maternal Graves' disease and/or its treatment with antithyroid medication, fetal heart block due to maternal anti-Ro and anti-La antibodies, fetal athrogryposis multiplex congenita in association with maternal myasthenia gravis and fetal brain hemorrhage due to maternal autoimmune thrombocytopenia. Read More

Arch Pediatr 2017 Jul 3;24(7):622-624. Epub 2017 Jun 3.

Clinique universitaire de néonatologie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France; Clinique universitaire de pédiatrie, HCE CHU de Grenoble, CS10217, 38430 Grenoble cedex 09, France.

Graves disease complicates two pregnancies out of 1000 and when it is known before pregnancy, it warrants careful monitoring of the fetus and the newborn. We report on a case of neonatal hyperthyroidism, which revealed a previously unknown maternal thyroid disease. In this situation, neonatal signs can be misinterpreted, delaying the diagnosis. Read More

Neuromuscul Disord 2017 Jul 4;27(7):655-657. Epub 2017 Apr 4.

Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:

We describe a 27-year-old pregnant female with new onset of conjugate gaze deficit during the third trimester of pregnancy. Repetitive nerve stimulation tests, neostigmine tests, and acetylcholine receptor antibody assays were all negative. The patient delivered a normal healthy baby at a local clinic via cesarean section. Read More

J Taibah Univ Med Sci 2017 Oct 5;12(5):461-464. Epub 2017 May 5.

Department of Neurology, King Fahd University Hospital, University of Dammam, Khobar, KSA.

Although rare, the co-occurrence of myasthenia gravis and preeclampsia during pregnancy is responsible for considerable maternal and foetal morbidity and mortality. Both careful selection of medications and a multidisciplinary approach are required for treating such cases. This study presents a case report of a patient with a known history of generalized myasthenia gravis who presented with preeclampsia at 33 weeks' gestation. Read More

Neuromuscul Disord 2017 Jun 18;27(6):537-541. Epub 2017 Jan 18.

Harry Perkins Institute for Medical Research and Centre for Medical Research, University of Western Australia, Nedlands, WA 6009, Australia.

Fetal akinesia deformation sequence is a clinically and genetically heterogeneous disorder characterized by a variable combination of fetal akinesia, intrauterine growth restriction, developmental abnormalities such as cystic hygroma, hydrops fetalis, pulmonary hypoplasia, occasional arthrogryposis, and pterygia. The pathogenetic mechanisms of fetal akinesia deformation sequence include neuropathy, muscular disorders, neuromuscular junction disorders, maternal myasthenia gravis, restrictive dermopathy and others. We here report an Egyptian family presenting with recurrent lethal multiple pterygium syndrome. Read More

J Neurol Sci 2017 Apr 4;375:241-244. Epub 2017 Feb 4.

Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria. Electronic address:

Rituximab (RTX) has emerged as an attractive off-label treatment option for patients with myasthenia gravis (MG) refractory to other immune therapies. However, data on long-term outcome after RTX for MG are still scarce. Here we present the 10-year outcomes [median (range) 10. Read More

Case Rep Obstet Gynecol 2017 9;2017:9204930. Epub 2017 Feb 9.

Department of Women, Children, and Family Health, University of Illinois College of Nursing at Rockford, 1601 Parkview Ave., Rockford, IL 61101, USA.

Myasthenia gravis (MG) is a rare autoimmune disease that leads to progressive muscle weakness and is common during female reproductive years. The myasthenic mother and her newborn must be observed carefully, as complications during all stages of pregnancy and the puerperium may arise suddenly. Preeclampsia is a common obstetrical condition for which magnesium sulfate is used for seizure prophylaxis. Read More

Neuromuscul Disord 2017 Apr 1;27(4):352-357. Epub 2017 Feb 1.

Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana (UFPR), Curitiba, Brazil. Electronic address:

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. Read More

Braz J Anesthesiol 2017 Mar - Apr;67(2):221-222. Epub 2014 Nov 22.

Yuzuncu Yil University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Van, Turkey.

Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. Read More

Rev Bras Anestesiol 2017 Mar - Apr;67(2):221-222. Epub 2017 Jan 10.

Yuzuncu Yil University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Van, Turquia.

Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. Read More

Retin Cases Brief Rep 2017 Winter;11 Suppl 1:S34-S37

*Loma Linda University Eye Institute, Loma Linda, California; and†Empire Eye Physicians, Coeur d'Alene, Idaho.

Purpose: To present a case of nonparaneoplastic autoimmune retinopathy in association with myasthenia gravis in a young woman, and to report the effect of plasmapheresis as well as passage of antiretinal antibodies through the placenta.

Methods: Case report.

Results: A 31-year-old woman presented with a history of myasthenia gravis and rapidly progressive vision loss at the age of 23. Read More

Int J STD AIDS 2017 08 18;28(9):902-909. Epub 2016 Nov 18.

1 Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.

The objective of this study was to describe the time required to obtain a negative chlamydia test in pregnant and nonpregnant women following treatment to inform test-of-cure collection and recommend an abstinence period to avoid reinfection. Seventy-two women with Chlamydia trachomatis infection, 36 pregnant and 36 nonpregnant, were enrolled in a prospective cohort study. Women were excluded less than 18 years of age, if they had been treated for chlamydia, reported an allergy to macrolide antibiotics, or if they had Myasthenia Gravis. Read More

Neurology 2016 Nov 21;87(20):2139-2145. Epub 2016 Oct 21.

From the Department of Neurology (M.I.B., A.H.M., C.M.E.T.) and Oslo Centre for Biostatistics and Epidemiology (C.B., H.W.-F.), Research Support Services, Oslo University Hospital, Norway; Department of Neurology (J.J.G.M.V.), Leiden University Medical Centre, the Netherlands; and Institute of Clinical Medicine (M.I.B., C.M.E.T.), University of Oslo, Norway.

Objective: To study the risk of clinical onset of myasthenia gravis (MG) in pregnancy and during the first 6 months postpartum because an association between pregnancy or the postpartum period and the onset of autoimmune MG is widely assumed but not proven.

Methods: The design was a cross-sectional population-based cohort study of 2 MG cohorts (Norway and the Netherlands) with 1,038 healthy controls from Norway. Data were obtained on 246 women with MG (age at onset 15-45 years). Read More

Crit Care Med 2016 Nov;44(11):2079-2103

1Geisinger Medical Center, Danville, PA. 2Albany Medical Center, Albany, NY. 3University of Arizona College of Pharmacy, Tucson, AZ. 4Clinic Medical Center, Burlington, MA. 5Indiana University, Indiana, IN. 6Grand Strand Medical Center, Myrtle Beach, SC. 7Baystate Medical Center, Springfield, MA. 8Saint Elizabeth's Medical Center, Boston, MA. 9University of Toronto, Toronto, Canada. 10Riverside Medical Group, Yorktown, VA. 11University of Nebraska Medical Center, Omaha, NE. 12Novant Health, Clemmons, NC. 13Massachusetts General Hospital, Boston, MA. 14Mayo Clinic, Rochester, MN. 15Lancaster General Hospital, Lancaster, PA. 16McMaster University, Hamilton, Ontario, Canada. 17Medscape, New York, NY. 18University of Toronto, Toronto, Canada.

Objective: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient."

Design: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. Read More

Tidsskr Nor Laegeforen 2016 Jul 5;136(12-13):1089-94. Epub 2016 Jul 5.

Nevrologisk avdeling Oslo universitetssykehus og Klinisk institutt Universitetet i Oslo.

Around 700 people in Norway have myasthenia gravis, an autoimmune disease that affects neuromuscular transmission and results in fluctuating weakness in some muscles as its sole symptom. The diagnosis is based on typical symptoms and findings, detection of antibodies and neurophysiological examination. Symptomatic treatment with acetylcholinesterase inhibitors is generally effective, but most patients also require immunosuppressive drug treatment. Read More

Neurology 2016 Jul 29;87(4):419-25. Epub 2016 Jun 29.

From the Department of Neurology (D.B.S., J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (G.I.W.), University at Buffalo School of Medicine and Biomedical Sciences, State University of New York; Department of Neurology (M.B.), University of Miami, Miller School of Medicine, FL; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Clinical Medicine (N.E.G.), University of Bergen, Norway; Department of Neurology (I.I.), Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; CIBERER U762 (I.I.), Barcelona, Spain; Departments of Pediatrics and Neurology (N.K.), Northwestern Feinberg School of Medicine, Chicago, IL; Neurologische Klinik (A.M.), Universitätsklinikum Erlangen; Hertie Institute for Clinical Research (A.M.), University of Tübingen, Germany; Department of Neurological Therapeutics (H.M.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Clinical Neurological Sciences (M.N.), Western University, London, Canada; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK; Department of Neurology (D.P.R.), University of California, Davis, CA; Department of Neurology (J.V.), Leiden University Medical Centre, Leiden, the Netherlands; and Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, MA.

Objective: To develop formal consensus-based guidance for the management of myasthenia gravis (MG).

Methods: In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness methodology was used to develop consensus guidance statements. Read More

Fetal Pediatr Pathol 2016 21;35(3):167-72. Epub 2016 Apr 21.

c Department of Endocrinology , School of Medicine, University of Belgrade, University Children's Hospital , Belgrade , Serbia.

Introduction: Acquired autoimmune myasthenia gravis (MG) is an autoimmune process in which antibodies (AB) directed against the acetylcholine nicotinic receptor (AChR) cause weakness and fatigue of striated muscles.

Objectives: The objective of this study was to determine the range of clinical manifestations in newborns with transient neonatal myasthenia (TNM).

Methods: 62 newborns with mothers who had autoimmune MG were followed by: anthropometric parameters, gestational age, gender, type of delivery completion, Apgar score (AS) in the first and fifth minute, and the emergence of TNM symptoms. Read More

J Pediatr 2016 Apr;171:201

Departments of Neurology, Pediatrics, and Human Biology, Stanford University Lucile Packard Children's Hospital, Palo Alto, California.

AJP Rep 2016 Mar;6(1):e133-6

Division of Maternal Fetal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.

Background Myasthenia gravis (MG) is an autoimmune disorder with fluctuating muscle weakness, divided into generalized and localized (ocular) forms. Maternal antibodies to acetylcholine receptors cross the placenta and may cause transient neonatal myasthenia gravis (TNMG). We present a case of seronegative maternal ocular MG and delayed TNMG. Read More

Muscle Nerve 2016 10 14;54(4):715-20. Epub 2016 Jul 14.

Obstetrics Department, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001, Oporto, Portugal.

Introduction: We evaluated the clinical course during pregnancy and neonatal outcomes of a cohort of Portuguese women with myasthenia gravis (MG).

Methods: Retrospective study.

Results: Twenty-five patients with 30 pregnancies were included. Read More