Description of 3 patients with myasthenia gravis and COVID-19

Rein, Netaniel; Haham, Nitzan; Orenbuch‐Harroch, Efrat; Romain, Marc; Argov, Zohar; Vaknin‐Dembinsky, Adi; Guillaume, Marc

doi:10.1016/j.jns.2020.117053

Cited by 42 publications

(53 citation statements)

References 6 publications

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“…There is little data regarding patients with NMD and COVID-19 infection. Cases of patients with myasthenia gravis who have had a SARS-CoV2 infection with a favorable evolution have been reported despite the fact that some have had to change their immunosuppressive treatment or have received treatment with hydroxychloroquine and/or antivirals (13)(14)(15)(16)).…”

Section: Covid-19 Infection In Nmd Patientsmentioning

confidence: 99%

Neuromuscular Diseases Care in the Era of COVID-19

Recasens

Rubio

2020

Front. Neurol.

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The COVID-19 pandemic has pushed health systems to their limit and forced readjustment of standards of care for different pathologies. Management of neuromuscular diseases becomes a challenge since most of them are chronic, disabling, progressive, and/or require immunosuppressive drugs. There are three main aspects of COVID-19 that affect neuromuscular diseases care. The first one relates to how SARS-CoV2 directly affects different neuromuscular pathologies. Respiratory weakness, as seen in myasthenia gravis, amyotrophic lateral sclerosis, and myopathies, and the use of immunomodulatory drugs (Myasthenia Gravis and Chronic Inflammatory Demyelinating Polyneuropathy) make this group of patients potentially more vulnerable. Secondly, safety measures also affect proper care, limiting care continuity, and physical rehabilitation (one of the essential aspects of myopathies treatment). Telemedicine can partially solve the problem allowing for a continuum of close care, avoiding unnecessary visits, and even guaranteeing the attention of professionals from tertiary care centers. However, one of the crucial steps in neuromuscular diseases is diagnosis, and in most scenarios, more than one face-to-face visit is needed. Lastly, the global COVID-19 situation will also have an economic impact on patients and their families. This situation is of particular concern given that neuromuscular diseases already present difficulties due to the scarcity of resources in terms of public healthcare and research.

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Section: Covid-19 Infection In Nmd Patientsmentioning

confidence: 99%

Neuromuscular Diseases Care in the Era of COVID-19

Recasens

Rubio

2020

Front. Neurol.

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“…[ 2 ] Long-term use of steroids in MG does not worsen COVID-19. [ 4 ] Using immunosuppressant agents in MG during the COVID-19 pandemic remains a challenge. A report from Brazil of MG patients with COVID-19 who were already on immunosuppressants showed favourable outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…There have been some case reports regarding COVID-19 in MG patients. [ [4] , [5] , [6] , [7] ] The course of disease and outcomes varied greatly. More than 50% of MG patients hospitalized due to COVID-19 had severe courses and that led to death in 30% of patients.…”

Section: Introductionmentioning

confidence: 99%

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Case series: COVID-19 in patients with mild to moderate myasthenia gravis in a National Referral Hospital in Indonesia

Octaviana¹,

Yugo²,

Safri³

et al. 2021

eNeurologicalSci

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Background During the COVID-19 pandemic, patients with myasthenia gravis (MG) are most likely to be affected by this situation. Corticosteroids and immunosuppressant agents increase the risk of severe infection. Furthermore, viral infection and some medications in COVID-19 may exacerbate MG symptoms. Case description We presented three patients with MG who contracted COVID-19. All of the patients had a favourable outcome. Only one patient who was not treated with corticosteroids or immunosuppressant therapy experienced deterioration of MG symptoms, while the other patients who received immunosuppressant therapy did not develop MG exacerbation. Surprisingly, azithromycin did not provoke myasthenic crisis (MC) in patients with normal MGFA classification. Conclusion Using immunosuppressant agents may not lead to MG deterioration and may not be related to unfavourable outcomes.

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“…According to the few publications available, the reaction of MG to an infection with SARS-CoV-2 is independent of the severity of the viral infection. There are reports showing that mild or even subclinical COVID-19 may trigger exacerbation of MG (5), and there are reports showing that MG patients with severe COVID-19 do not experience an exacerbation of MG (5). The prevalence of exacerbations is also independent of the severity of the COVID-19 infection, as assessed by the CALL score (used for predicting the outcome of COVID-19 patients) (18).…”

Section: Does An Infection With Sars-cov-2 Worsen or Exacerbate Myastmentioning

confidence: 99%