Myasthenia Gravis – Exacerbation and Crisis

Schroeter, Michael; Kaiser, Jocelyn

doi:10.1055/s-0043-118441

Cited by 14 publications

(14 citation statements)

References 18 publications

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“…A disease exacerbation was defined as fulfilment all of the following criteria as adapted from national guidelines [ 15 ]: Objective: QMG (quantitative myasthenia gravis) score [ 16 ] of ≥ 8 points and a minimum increase of ≥ 5 points from the previous visit. Ocular findings must not account for more than 5 points on the QMG score.…”

Section: Methodsmentioning

confidence: 99%

Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients

Nelke

Stascheit

Eckert

et al. 2022

J Neuroinflammation

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Background Myasthenic crisis (MC) and disease exacerbation in myasthenia gravis (MG) are associated with significant lethality and continue to impose a high disease burden on affected patients. Therefore, we sought to determine potential predictors for MC and exacerbation as well as to identify factors affecting outcome. Methods We examined a retrospective, observational cohort study of patients diagnosed with MG between 2000 and 2021 with a mean follow-up of 62.6 months after diagnosis from eight tertiary hospitals in Germany. A multivariate Cox regression model with follow-up duration as the time variable was used to determine independent risk factors for MC and disease exacerbation. Results 815 patients diagnosed with MG according to national guidelines were included. Disease severity at diagnosis (quantitative MG score or Myasthenia Gravis Foundation of America class), the presence of thymoma and anti-muscle specific tyrosine kinase-antibodies were independent predictors of MC or disease exacerbation. Patients with minimal manifestation status 12 months after diagnosis had a lower risk of MC and disease exacerbation than those without. The timespan between diagnosis and the start of immunosuppressive therapy did not affect risk. Patients with a worse outcome of MC were older, had higher MGFA class before MC and at admission, and had lower vital capacity before and at admission. The number of comorbidities, requirement for intubation, prolonged mechanical ventilation, and MC triggered by infection were associated with worse outcome. No differences between outcomes were observed comparing treatments with IVIG (intravenous immunoglobulin) vs. plasma exchange vs. IVIG together with plasma exchange. Conclusions MC and disease exacerbations inflict a substantial burden of disease on MG patients. Disease severity at diagnosis and antibody status predicted the occurrence of MC and disease exacerbation. Intensified monitoring with emphasis on the prevention of infectious complications could be of value to prevent uncontrolled disease in MG patients. Graphical Abstract

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Section: Methodsmentioning

confidence: 99%

Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients

Nelke

Stascheit

Eckert

et al. 2022

J Neuroinflammation

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“…It is also proven that cortisone has a positive effect when used as add-on therapy with PLEX/IA and IVIG. 8 Our study aims to present a myasthenia gravis case with features of MG exacerbation following the administration of a second dose of AZD1222.…”

Section: Highlightsmentioning

confidence: 99%

Myasthenia Gravis Exacerbation Following COVID-19 Vaccine: A Case Report

Gabralla¹,

Bashir

Mohamed³

2023

Int J Med Stud

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Background: Vaccination remains the mainstay of strategy for prevention of Coronavirus Disease-2019 (COVID-19). AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by the WHO in mid-February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure. The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her normally well-controlled MG following her second dose of AZD1222 vaccination. She continued to deteriorate and was admitted to the intensive care unit, where she was intubated and placed on a mechanical ventilator. The low-income setting was a major barrier in obtaining intravenous immunoglobulin until the patient died. Our study aims to present an MG case with features of MG exacerbation following administration of a second dose of AZD1222. Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. In our case, an exacerbation of MG may have been precipitated by the COVID-19 AstraZeneca vaccine. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients

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“…11 12 However, 20% of patients with ocular symptoms will continue to demonstrate isolated ptosis and diplopia. 13 MG is considered ocular only after 3 months of isolated ocular symptoms and observation up to 2 years while symptoms are still localized only to extraocular muscles. 13…”

Section: Clinical Typesmentioning

confidence: 99%

“…13 MG is considered ocular only after 3 months of isolated ocular symptoms and observation up to 2 years while symptoms are still localized only to extraocular muscles. 13…”

Section: Clinical Typesmentioning

confidence: 99%

Disease-Based Prognostication: Myasthenia Gravis

Almodovar,

Mehrabyan

2023

Semin Neurol

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Myasthenia gravis (MG) is an acquired autoimmune neuromuscular junction transmission disorder that clinically presents as fluctuating or persistent weakness in various skeletal muscle groups. Neuroprognostication in MG begins with some basic observations on the natural history of the disease and known treatment outcomes. Our objective is to provide a framework that can assist a clinician who encounters the MG patient for the first time and attempts to prognosticate probable outcomes in individual patients. In this review article, we explore clinical type, age of onset, antibody status, severity of disease, thymus pathology, autoimmune, and other comorbidities as prognostic factors in MG.

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Myasthenia Gravis – Exacerbation and Crisis

Cited by 14 publications

References 18 publications

Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients

Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients

Myasthenia Gravis Exacerbation Following COVID-19 Vaccine: A Case Report

Disease-Based Prognostication: Myasthenia Gravis

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