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Rudolf R, Kettelhut IC, Navegantes LCC. Sympathetic innervation in skeletal muscle and its role at the neuromuscular junction. J Muscle Res Cell Motil 2024; 45:79-86. [PMID: 38367152 PMCID: PMC11096211 DOI: 10.1007/s10974-024-09665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
Neuromuscular junctions are the synapses between motor neurons and skeletal muscle fibers, which mediate voluntary muscle movement. Since neuromuscular junctions are also tightly associated with the capping function of terminal Schwann cells, these synapses have been classically regarded as tripartite chemical synapses. Although evidences from sympathetic innervation of neuromuscular junctions was described approximately a century ago, the essential presence and functional relevance of sympathetic contribution to the maintenance and modulation of neuromuscular junctions was demonstrated only recently. These findings shed light on the pathophysiology of different clinical conditions and can optimize surgical and clinical treatment modalities for skeletal muscle disorders.
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Affiliation(s)
- Rüdiger Rudolf
- Center for Mass Spectrometry and Optical Spectroscopy, Mannheim University of Applied Sciences, 68163, Mannheim, Germany.
- Interdisciplinary Center for Neurosciences, Heidelberg University, 69117, Heidelberg, Germany.
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim Heidelberg University, 69167, Mannheim, Germany.
| | - Isis C Kettelhut
- Department of Biochemistry & Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, 14049900, Brazil
| | - Luiz Carlos C Navegantes
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, 14049900, Brazil
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Crescioli G, Finocchietti M, Paoletti O, Brunori P, Sciancalepore F, Tuccori M, Addis A, Vannacci A, Lombardi N, Kirchmayer U. Potentially inappropriate drug use in myasthenia gravis: a real-world population-based cohort study in Italy. Front Neurol 2023; 14:1293626. [PMID: 38178892 PMCID: PMC10764541 DOI: 10.3389/fneur.2023.1293626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction To evaluate the use of pyridostigmine in presence of contraindications, and the use of concomitant potentially contraindicated drugs in a cohort of patients affected by Myasthenia Gravis (MG) in the Italian Regions of Lazio, Tuscany, and Umbria. Methods This is a retrospective cohort study. A multivariate logistic regression model was used to evaluate the determinants of pyridostigmine and of potentially contraindicated drugs use in MG patients. Results Among 591 incident pyridostigmine users affected by MG, 91 (15.4%) had at least one of the contraindications considered at the first prescription of pyridostigmine. Patients prescribed with pyridostigmine in presence of contraindications were more frequently affected by diabetes, obesity, and renal diseases. Age 75+ years (odds ratio, OR 4.94, 95% confidence interval, CI 1.60-15.22 for Latium; OR 3.78, 95%CI: 1.26-11.34 for Tuscany; OR 5.83, 95%CI 1.19-28.52 for Umbria), the presence of at least one specific comorbidity (OR 3.93; 95%CI 1.68-9.17 for Latium), and polytherapy (6+ drugs, OR 4.90, 95%CI: 1.35-17.85 for Tuscany) were found to be significantly associated with pyridostigmine use in presence of contraindications. Among patients affected by MG, 1,483 (62.6%) were treated with potentially contraindicated drugs in the first year of follow-up (67.06.9% in Latium; 59% in Tuscany; 57.6% in Umbria). Patients aged 75+ years, those with at least one specific complication or comorbidity, and those exposed to polytherapy were more likely to be treated with a potential contraindicated drug. Conclusion Among incident users of pyridostigmine, more than 15% of patients have at least one of the contraindications considered, and among patients diagnosed with MG, in the first year of follow-up >60% of subjects were treated with potentially contraindicated drugs.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | | | - Olga Paoletti
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Paola Brunori
- Unit of Neurophysiopathology, Perugia Hospital, Perugia, Italy
| | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Marco Tuccori
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
- Department of Clinical and Experimental Medicine, Unit of Pharmacology and Pharmacovigilance, University of Pisa, Pisa, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Jessop K. Intravenous magnesium sulfate inducing acute respiratory failure in a patient with myasthenia gravis. BMJ Case Rep 2022; 15:e250455. [PMID: 35738845 PMCID: PMC9226880 DOI: 10.1136/bcr-2022-250455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman in her 90s with a background of myasthenia gravis and atrial fibrillation presented to hospital following a fall. While in the emergency department it was noted that she was in atrial fibrillation with a fast-ventricular response and as part of her management was given intravenous magnesium. Following this she developed acute respiratory failure and required intubation and ventilation. The patient recovered quickly and was extubated in the intensive care unit the next day. On subsequent days, the patient received two further doses of intravenous magnesium before the link was identified. On both of these occasions she again developed respiratory failure which were managed with non-invasive ventilation. This case highlights the importance of all members of the team being aware of the drugs that can induce a myasthenic crisis. It also stimulates further research into the development of a guide of how to safely treat symptomatic hypomagnesaemia in patients with myasthenia gravis.
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Affiliation(s)
- Kayleigh Jessop
- Anaesthetics, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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