Guidance for the management of myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) during the COVID-19 pandemic

Abstract

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COVID-19 and neuromuscular disorders

“…17 In terms of managing ISTs, consensus statements are emerging to guide patients and clinicians until we have data published on outcomes. 18 Most outpatients without infection should continue to take their medications, with instructions to call their neurologist and temporarily hold the medication if they develop symptoms of infection. In some cases, after discussion of risk and benefit between the patient and provider, some patients may be able to continue ISTs or be treated with a different, less immunosuppressive option.…”

COVID‐19 in patients with myasthenia gravis

“…Four of five immunosuppressed patients presented here had favorable outcomes.Patients 2 and 3 had MMF held during the course of their illness;the impact of this short-term discontinuation of MMF is unclear, as studies suggest that the drug may remain active for up to 6 weeks after cessation 21. As suggested by existing expert consensus guidelines,9 decisions regarding continuation of immunosuppression and initiation of acute interventions, such as high-dose corticosteroids and IVIg, should be made on a case-by-case basis based on the relative severities of COVID-19 and MG. Of note, although an increased risk of thromboembolic events has been described in both patients receiving IVIg and those with COVID-19, 22 patients 3 and 4 in our series received IVIg without complications. These 5 patients with COVID and MG demonstrate the unique evaluation and management considerations in this patient population.…”

Neuropathogenic human coronaviruses: A review

“…Apart from viral replication‐induced direct neural damage (ie, virus‐induced neuropathology), it is also possible that HCoV infections, as result of the misdirected host autoimmune responses in susceptible patients, promote indirect neural damage (ie, virus‐induced neuro‐immunopathology) 14‐16 (Figure 1). On the other hand, pre‐existing neurological disorders, particularly autoimmune diseases and the immunosuppressive or immunomodulatory therapies, may indirectly induce or exacerbate immune‐mediated neural damage by HCoVs 17,18 …”

“…HCoV infections, in more vulnerable patients, can induce an exacerbation of underlying neurological conditions via virus‐induced neuro‐immunopathology 14‐16,44,45 . It has been recognised that patients with pre‐existing neurological diseases, such as myasthenia gravis, 18 cerebrovascular stroke, 17,19,20 Parkinson's disease, 17,40,41 multiple sclerosis, 17,40,42 and other demyelinating disorders, 17,40,41 may be at a higher risk of contracting infection with SARS‐CoV‐2 or experiencing severe manifestations of COVID‐19. The reverse is also possible that the body's response to HCoVs infections, including COVID‐19, may cause worsening of symptoms of the patients' underlying neurological diseases.…”

“…The reverse is also possible that the body's response to HCoVs infections, including COVID‐19, may cause worsening of symptoms of the patients' underlying neurological diseases. This could be attributed to certain risk factors associated with these patients, such as old age, significantly restricted mobility, intake of immunosuppressive or immunomodulatory drugs, and presence of chronic medical conditions, including diabetes mellitus, lung diseases, cardiovascular diseases, renal diseases, liver diseases, and cancer 17,18 …”