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BackgroundExisting data regarding the link between COVID‐19 vaccine and myasthenia gravis (MG) are scarce. We aimed to assess the association between Pfizer‐BioNTech vaccine with both new‐onset MG and MG exacerbation.MethodsFor the first aim, we conducted a nested case‐control study in a cohort of 3,052,467 adults, without a diagnosis of MG, from the largest healthcare provider in Israel. Subjects were followed from January 1, 2021, until June 30, 2022, for the occurrence of MG. Ten randomly selected controls were matched to each case of new‐onset MG on age, and sex. For the second aim, a nested case‐control study was conducted in a cohort of 1,446 MG patients. Four randomly selected MG patients (controls) were matched to each case of MG exacerbation. Exposure to COVID‐19 vaccine in the prior four weeks was assessed in cases and controls.ResultsOverall, 332 patients had new‐onset MG and were matched with 3,320 controls. Multivariable conditional logistic regression models showed that the OR for new‐onset MG, associated with COVID‐19 vaccine, was 1.14 (95% CI, 0.73‐1.78). The results were consistent in sensitivity analysis that used more stringent criteria to define MG. Overall, 62 patients with MG exacerbation were matched to 248 MG controls. The multivariable OR for MG exacerbation, associated with COVID‐19 vaccine, was 1.35 (0.37‐4.89). All results were similar when the prior exposure to COVID‐19 vaccine was extended to 8 weeks.ConclusionsThis study suggests that Pfizer‐BioNTech vaccine is not associated with increased risk of new‐onset nor exacerbation of myasthenia gravis.

Background: Many languages use spatial metaphors to describe affective states such as an upward bias to denote positive mood, a downward bias to denote negative mood, a body proximity bias to denote personal relatedness concern, and a right-left bias to denote negative or positive valence. These biases might be related to experiential traces related to these affective states. If this is the case, depressed subjects would show either a downward spatial bias, a body proximity bias, or a right-left shift in attention. We evaluated the occurrence of such biases in subjects with depression compared to healthy controls.Methods: Subjects: 10 subjects with depression (5F:5M; age = 47.2 ± 15.2) and 10 healthy controls (5F:5M; age = 45.8 ± 14.5). Experimental task: line bisection task. Lines were presented in three spatial orientations [vertical (up-down), horizontal (right-left), radial (proximal-distal)] and were either blank, composed with words (negative/positive/neutral), or with smileys (negative/positive/neutral). There were 21 line types, and each was presented eight times, reaching a total of 168 lines.Results: Compared with healthy controls, subjects with depression bisected radial lines significantly closer to their body. There were no significant differences for either horizontal or vertical lines.Conclusion: The proximity spatial bias observed in subjects with depression suggests that depression might activate neural spatial networks. We argue that these networks could be dynamically activated through narcissistic mechanisms as implied in “Mourning and Melancholia” where Freud postulates a narcissistic mediated bias in depression according to which the depressed subjects withdraw from the outside world.