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Case Rep Neurol 2021 Jan-Apr;13(1):65-72. Epub 2021 Feb 1.

Department of Neurology, University of South Florida, Tampa, Florida, USA.

The recombinant humanized monoclonal antibody eculizumab has been shown to be effective and well tolerated in patients with anti-acetylcholine receptor antibody-positive, treatment-refractory generalized myasthenia gravis (gMG). Myasthenia gravis (MG) often affects women of child-bearing potential. However, management can be challenging during pregnancy, and current treatment options are limited due to potential teratogenicity. Read More

Rev Neurol (Paris) 2021 Mar 26;177(3):215-219. Epub 2021 Feb 26.

Service d'électroneuromyographie et pathologies neuromusculaires - Hôpital Pierre-Wertheimer - CHU de Lyon HCL - GH Est, 59, boulevard Pinel, Bron cedex, Lyon, France. Electronic address:

Myasthenia gravis is an autoimmune disease characterised by fluctuating muscle weakness, which worsens during activity. It affects particularly scapular and pelvic girdles, axial and bulbar muscles. Myasthenia gravis is twice more frequent in women and symptoms often appear in the second and third decade of life. Read More

Zhonghua Nei Ke Za Zhi 2021 Feb;60(2):117-121

Department of Neurology, the First Medical Center of PLA General Hospital, Beijing 100853,China.

To study the clinical characteristics of pregnant patients with myasthenia gravis (MG) and the influence of MG to pregnancy. A retrospective study was conducted including 28 MG patients with 38 pregnancies admitted to the 8th Medical Center of PLA General Hospital between January 2013 and October 2018. Data were collected including clinical scores of MG, serum level of acetylcholine receptor (AChR) antibodies, abnormal repetitive nerve stimulation (RNS) and history of thymectomy before pregnancy. Read More

Can J Neurol Sci 2021 Jan 12:1-5. Epub 2021 Jan 12.

Department of Medicine, Division of Neurology, Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada.

Background: Myasthenia gravis (MG) is an autoimmune disorder that frequently affects young women of reproductive age. The multidirectional interplay between MG, pregnancy, and fetal health poses a complex scenario for pregnant women with MG and the healthcare team. Here, we reviewed our local experience with MG, pregnancy, and outcomes. Read More

J Matern Fetal Neonatal Med 2020 Nov 1:1-6. Epub 2020 Nov 1.

Department of Obstetrics and Gynecology, Maternal and Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Objective: To survey OB-GYNs regarding their practice patterns and perspectives when it comes to using magnesium sulfate (magnesium) in the prevention of eclampsia.

Study Design: We conducted a cross-sectional web-based 18-item survey given to 564 practicing OB-GYNs in the Pregnancy-Related Care Research Network. The survey used clinical scenarios to look at provider practices for preventing eclampsia in patients who have preeclampsia and relative contraindications to magnesium. Read More

Medicine (Baltimore) 2020 Oct;99(44):e22978

King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal medicine department, Neurology Division, Jeddah, Saudi Arabia.

This cross-sectional study aimed to assess the impact of epilepsy, myasthenia gravis (MG), and multiple sclerosis (MS) on pregnancy and family planning decision-making in a cohort of Saudi women. Women with epilepsy, MG, and MS were recruited consecutively at the time of their follow-up visits at a neurology clinic. Data were collected using 3 standardized questionnaires, and presented using descriptive statistics. Read More

Muscle Nerve 2020 12 28;62(6):664-672. Epub 2020 Sep 28.

Department of Neurology, Henry Ford Hospital, Detroit, Michigan.

Myasthenia gravis (MG) is an autoimmune disorder with bimodal age of presentation, occurring in young women of reproductive age and at an older age in men. Occasionally, MG is diagnosed during pregnancy. Management of MG includes symptomatic treatment with cholinesterase inhibitors and immunosuppressive therapy for controlling the disease activity. Read More

Ther Adv Neurol Disord 2020 25;13:1756286420949808. Epub 2020 Aug 25.

Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Gudrunstrasse 56, Bochum, 44791, Germany.

Neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis (AE), myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are antibody-mediated neurological diseases. They have mostly female predominance, affecting many women during childbearing age. Interactions between the underlying disease (or necessary treatment) and pregnancy can occur in every of these illnesses. Read More

J Allergy Clin Immunol 2020 09;146(3):467-478

Weill Cornell Medicine, New York, NY.

The humoral immune response provides specific, long-lived protection against invading pathogens, via immunoglobulin production and other memory functions. IgG, the most abundant immunoglobulin isotype, has the longest half-life and protects against bacterial and viral infections. The neonatal Fc receptor (FcRn) transports IgG across barriers, for example, the placenta, enhancing fetal humoral immunity to levels similar to their mothers'. Read More

Toxins (Basel) 2020 08 7;12(8). Epub 2020 Aug 7.

Poison Control Centre and National Toxicology Information Centre-Toxicology Unit Istituti Clinici Scientifici Maugeri IRCCS, Maugeri Hospital, Pavia Via Salvatore Maugeri, 10, 27100 Pavia, Italy.

Botulinum neurotoxins (BoNTs) produced by species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. Read More

Handb Clin Neurol 2020 ;172:201-218

Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States. Electronic address:

Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Read More

J Perinat Med 2020 Oct;48(8):793-798

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.

Objectives Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction marked by weakness and fatiguability of skeletal muscle. MG has an unpredictable course in pregnancy. Our purpose was to evaluate the effect of MG on maternal and neonatal outcomes. Read More

Handb Clin Neurol 2020 ;171:119-141

Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States. Electronic address:

Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages. Read More

Int J Neurosci 2020 Jul 23:1-6. Epub 2020 Jul 23.

Departments of Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas City, MO USA.

Background: Myasthenic crisis is characterized by severe weakness in bulbar and respiratory muscles leading to respiratory failure and can be a natural result of myasthenia gravis or precipitate due to infections, surgeries, and pregnancy. It has been shown that stressful emotional events can lead to stress, or takotsubo cardiomyopathy. Takotsubo cardiomyopathy is characterized by transient reversible left ventricular dysfunction in the absence of obstructive artery disease with hypo- or akinesis of the apex with hypercontractility of the base. Read More

Front Neurol 2020 12;11:554. Epub 2020 Jun 12.

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

Myasthenia gravis (MG) with onset below 50 years, thymic hyperplasia and acetylcholine receptor (AChR) antibodies is more common in females than in males. For a relatively large group of MG patients, pregnancy represents therefore an important question. The muscle weakness, the circulating autoantibodies, the hyperplastic thymus, the MG drug treatment, and any autoimmune comorbidity may all influence both mother and child health during pregnancy and also during breastfeeding in the postpartum period. Read More

Trials 2020 Jun 10;21(1):513. Epub 2020 Jun 10.

Department of Respiratory Medicine, Odense University Hospital University of Southern Denmark, Odense, Denmark.

Objectives: The aim of this randomised GCP-controlled trial is to clarify whether combination therapy with the antibiotic azithromycin and hydroxychloroquine via anti-inflammation/immune modulation, antiviral efficacy and pre-emptive treatment of supra-infections can shorten hospitalisation duration for patients with COVID-19 (measured as "days alive and out of hospital" as the primary outcome), reduce the risk of non- invasive ventilation, treatment in the intensive care unit and death.

Trial Design: This is a multi-centre, randomised, Placebo-controlled, 2-arm ratio 1:1, parallel group double-blind study.

Participants: 226 participants are recruited at the trial sites/hospitals, where the study will take place in Denmark: Aalborg, Bispebjerg, Gentofte, Herlev, Hillerød, Hvidovre, Odense and Slagelse hospitals. Read More

Trials 2020 Jun 3;21(1):466. Epub 2020 Jun 3.

Clinical Pharmacology Department, Clinical Trial Unit, La Paz University Hospital - IdiPAZ, Paseo de la Castellana, 261, 28046, Madrid, Spain.

Objectives: Primary objective: to evaluate the efficacy of melatonin as a prophylactic treatment on prevention of symptomatic SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Secondary objectives: To evaluate the efficacy of melatonin as a prophylactic treatment on prevention of asymptomatic SARS-CoV-2 infection.To evaluate the efficacy of melatonin to prevent the development of severe COVID-19 in the participants enrolled in this study who develop SARS-CoV-2 infection along the trial. Read More

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

Minerva Ginecol 2020 Feb;72(1):30-35

Department of Obstetrics and Gynecology, Sapienza University, Rome, Italy.

Introduction: Myasthaenia gravis (MG) is the most common disease of the neuromuscular junction; clinical presentation of the disease includes a variety of symptoms, the most frequent beign the only ocular muscles involvement, to the generalized myasthenic crisis with diaphragmatic impairment and respiratory insufficiency. It is most common in women between 20 ad 40 years.

Evidence Acquisition: We performed a comprehensive search of relevant studies from January1990 to Dicember 2019 to ensure all possible studies were captured. Read More

Cell Stem Cell 2020 02 16;26(2):172-186.e6. Epub 2020 Jan 16.

Stem Cell Modelling of Development & Disease Group, Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany. Electronic address:

Neuromuscular networks assemble during early human embryonic development and are essential for the control of body movement. Previous neuromuscular junction modeling efforts using human pluripotent stem cells (hPSCs) generated either spinal cord neurons or skeletal muscles in monolayer culture. Here, we use hPSC-derived axial stem cells, the building blocks of the posterior body, to simultaneously generate spinal cord neurons and skeletal muscle cells that self-organize to generate human neuromuscular organoids (NMOs) that can be maintained in 3D for several months. 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

Reprod Biomed Online 2019 Apr 7;38(4):621-633. Epub 2018 Dec 7.

Department of Gynaecology and Obstetrics, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy. Electronic address:

As all the structures of the human eye are characterized by sex hormone receptors, this study tested the hypothesis that assisted reproductive technology (ART) treatment influences visual function and ocular morphology in women who have undergone ART treatment and children born as a result of ART treatment. A systematic literature search of all original articles published up to August 2018 was performed using the PubMed database, including all original studies available in the literature. Review articles, studies in which participants underwent mixed interventions (i. 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