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Sacconi S, Vanoli F, Stascheit F, Cortés-Vicente E, Mantegazza R, Meisel A. 278th ENMC International Workshop: European standards for harmonization of myasthenia gravis registries and emerging digital solutions. 20th-21st September 2024, Hoofddorp, The Netherlands. Neuromuscul Disord 2025; 51:105368. [PMID: 40388880 DOI: 10.1016/j.nmd.2025.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2025] [Accepted: 04/23/2025] [Indexed: 05/21/2025]
Abstract
The European Neuromuscular Centre workshop convened a diverse array of key stakeholders dedicated to the European standards for harmonization of national Myasthenia Gravis registries and emerging digital solutions. Participants included representatives from the pharmaceutical industry, patient advocacy organizations, clinicians with expertise in Myasthenia Gravis, and members of the European Reference Network for Rare Neuromuscular Diseases. This multidisciplinary composition, as well as preliminary activities, fostered robust discussions and facilitated the identification of shared objectives for future endeavors to allow collaboration at European level among national Myasthenia Gravis registries. Throughout the workshop sessions, relevant topics emerged, highlighting both the challenges and strengths towards harmonizing data on myasthenia gravis in national registries and improving outcomes for patients with myasthenia.
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Affiliation(s)
- Sabrina Sacconi
- Peripheral Nervous System & Muscle Department, Reference Center for Neuromuscular Disorders, Pasteur 2 Hospital, Nice University Hospital, Nice, France.
| | - Fiammetta Vanoli
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Frauke Stascheit
- Department of Neurology with Experimental Neurologie, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andreas Meisel
- Department of Neurology with Experimental Neurologie, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
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Jiang A, Hu Q, Wang Z, Wu F. Efficacy and Safety of Tacrolimus Therapy in Patients With Juvenile Myasthenia Gravis: A Single-Arm Meta-Analysis. Pediatr Neurol 2025; 166:32-38. [PMID: 40081091 DOI: 10.1016/j.pediatrneurol.2025.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 01/26/2025] [Accepted: 02/16/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND Numerous guidelines recommend off-label use of tacrolimus (TAC) to treat myasthenia gravis (MG) in adults. This study aimed to evaluate whether TAC is beneficial in pediatric patients with juvenile MG (JMG). METHODS We conducted a systematic literature search using the keywords "Myasthenia Gravis," "TAC," "juveniles," and their synonyms. PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases were searched for articles published until April 1, 2024. Two reviewers independently identified and extracted relevant retrospective/prospective comparison studies or randomized controlled trials and assessed the risk of bias for each study. Eligible studies were subsequently included in a meta-analysis that evaluated the clinical outcomes of TAC treatment for JMG using fixed- and random-effects models. RESULTS Of the 203 articles initially identified, nine were included in the meta-analysis. These studies included 313 children diagnosed with JMG, with ages ranging from 0 to 13.5 years. Among the included studies, two were comparison trials, whereas the remaining seven employed a single-group pretest-post-test design. Two studies were deemed to be of high quality, and seven were of moderate quality. The pooled overall response rate of the definite responder rate to TAC treatment in JMG was calculated as 3.92 (95% confidence interval: 2.06 to 7.45, I2 = 71%, P < 0.001). CONCLUSIONS This meta-analysis found that TAC improved symptoms and MG-related scores in patients with JMG with minimal adverse effects. These findings underscore the importance of TAC therapy for the treatment of JMG.
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Affiliation(s)
- Aidou Jiang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaozhi Hu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhidan Wang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
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Jen R, Momirovski D, Andrews S. A Juvenile Myasthenia Gravis Crisis in a Previously Undiagnosed Child-A Case Report. J Paediatr Child Health 2025. [PMID: 40302300 DOI: 10.1111/jpc.70071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2025] [Accepted: 04/21/2025] [Indexed: 05/02/2025]
Affiliation(s)
- Roger Jen
- Department of General Paediatrics, Western Health, St Albans, Australia
| | - Deyan Momirovski
- Department of General Paediatrics, Western Health, St Albans, Australia
| | - Sarah Andrews
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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He N, Tian L, Jin J, Liu Y, Li L, Wang X, Li D, Wang X, Li X, Chen Z, Zhang L, Qiao L, Ning S, Wang L, Wang J. Identification and validation of lncRNA mutation hotspot SNPs associated with myasthenia gravis susceptibility. Noncoding RNA Res 2025; 11:209-219. [PMID: 39896342 PMCID: PMC11786913 DOI: 10.1016/j.ncrna.2024.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/17/2024] [Accepted: 12/29/2024] [Indexed: 02/04/2025] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disorder caused by antibodies that target the postsynaptic muscle membrane. Recent evidence suggests that genetic variants and long noncoding RNAs (lncRNAs) play crucial roles in the pathogenesis of MG. The purpose of this study was to investigate the associations between lncRNA-related single-nucleotide polymorphisms (SNPs) and MG susceptibility in Chinese populations. Methods First, we identified lncRNA mutation hotspot regions based on the improved Kolmogorov‒Smirnov test and the cumulative hypergeometric distribution principle. Next, we further identified lncRNA mutation hotspot SNPs by calculating conservative scores. Finally, experiments were conducted to verify the associations between lncRNA mutation hotspot SNPs and MG susceptibility. A total of 82 patients with MG and 82 healthy controls were recruited for genotyping of lncRNA mutation hotspot SNPs using the SNaPshot technique. Quantitative real-time PCR was used to investigate lncRNA expression in 34 patients with MG and 37 healthy controls. Results In the multistep calculation, 14 candidate SNPs of 3 lncRNAs (AL031686.1, NONHSAT028539.2 and AC245014.3) in MG were identified as mutation hotspot SNPs. The genotyping results of the 14 SNPs in our study revealed no statistically significant differences in the frequencies of genotypes and alleles between patients with MG and controls. However, in the lncRNA AL031686.1, rs1000383 and rs6094353 were in perfect linkage disequilibrium (LD) and were associated with an increased risk of ocular MG. Additionally, rs6094347 was associated with an increased risk of ocular MG. Nevertheless, no SNP was found to be associated with factors such as sex, age, the presence or absence of thymoma, or the genetic model of MG. Further experiments revealed that NONHSAT028539.2 expression was upregulated in peripheral blood mononuclear cells (PBMCs) from patients with MG compared with those from healthy controls. Conclusion In our study, we did not find an association between the 14 mutation hotspot SNPs of lncRNAs and susceptibility to MG. However, we observed that the rs6094347 and rs1000383/rs6094353 polymorphisms in the lncRNA AL031686.1 were associated with the risk of ocular MG.
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Affiliation(s)
- Ni He
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Liting Tian
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingnan Jin
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Liu
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Lifang Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaokun Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Danyang Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoju Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zihong Chen
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lanxin Zhang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lukuan Qiao
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianjian Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wang G, Kessi M, Huang X, Zhang W, Zhang C, He F, Peng J, Yin F, Yang L. Treatment of juvenile myasthenia gravis with tacrolimus: A cohort study. Eur J Neurol 2024; 31:e16466. [PMID: 39230556 PMCID: PMC11555145 DOI: 10.1111/ene.16466] [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: 05/20/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND We investigated the proper timing, efficacy and safety of tacrolimus for juvenile myasthenia gravis (JMG). METHODS We conducted a retrospective cohort study for JMG patients treated with tacrolimus at Xiangya Hospital, Central South University, Changsha, China from 2010 to 2023. The clinical information of patients with a follow-up of more than 1 year was collected. Comparisons of clinical features between groups of patients who achieved therapeutic goal and those who did not achieve therapeutic goal as well as between groups of patients treated with tacrolimus within or after 1 year from JMG onset was carried out. RESULTS Forty-three patients were enrolled, of whom 28 achieved therapeutic goal. Tacrolimus reduced glucocorticoids (GC) dosages for the 28 cases and 15 cases discontinued GC completely. Generalized myasthenia gravis (GMG) subtype had an association with a group of patients who achieved therapeutic goal (p = 0.001). Median duration from JMG onset to tacrolimus use was 10.50 months for those who achieved therapeutic goal and 36.00 months for those who did not achieve therapeutic goal (p = 0.010). The median Myasthenia Gravis Activities of Daily Living (MG-ADL) score improved significantly (p = 0.003). The initiation of tacrolimus within 1 year of JMG onset showed an association with achievement of therapeutic goal (p = 0.026). GMG subtype showed an association with a group of patients who received tacrolimus within 1 year (p = <0.001). Tacrolimus side effects were tolerable. CONCLUSION The provision of tacrolimus within 1 year of JMG onset is effective and safe.
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Affiliation(s)
- Guoli Wang
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Miriam Kessi
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
| | - Xi Huang
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
| | - Wen Zhang
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Ciliu Zhang
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Fang He
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Jing Peng
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Fei Yin
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
| | - Lifen Yang
- Department of PediatricsXiangya Hospital, Central South UniversityChangshaChina
- Hunan Intellectual and Developmental Disabilities Research CenterChangshaChina
- Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan ProvinceXiangya Hospital, Central South UniversityChangshaChina
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Evoli A, Palace J, Spagni G, Cheli M, Ruiter A, Verschuuren J, Maggi L. 275th ENMC international workshop: Seronegative myasthenia gravis: An update paradigm for diagnosis and management, 9-11 February 2024, Hoofddorp, the Netherlands. Neuromuscul Disord 2024; 44:104468. [PMID: 39427494 DOI: 10.1016/j.nmd.2024.104468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 10/01/2024] [Indexed: 10/22/2024]
Abstract
The 275th ENMC workshop on the diagnosis and management of seronegative myasthenia gravis (SNMG) was held on February 9-11, 2024. The participants included experts in the field of adult and pediatric MG together with patient representatives. This workshop aimed to redefine SNMG in view of recent diagnostic and therapeutic updates and to identify patient unmet needs. The workshop has highlighted considerable challenges in the SNMG diagnostic work-up. To date, SNMG confirmation is often controversial, given the absence of specific diagnostic tests; no recommendations from international panels of experts are available in literature; myopathies, congenital myasthenic syndromes and functional disorders are the commonest misdiagnoses. Improving the disease diagnosis is crucial to avoid long delays in receiving appropriate treatment. To this purpose, a comprehensive diagnostic algorithm achieved consensus. Moreover, a remarkable variability in SNMG response to therapy and long-term prognosis has also been highlighted.
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Affiliation(s)
- Amelia Evoli
- Neuroscience Department, Università Cattolica, Roma, Italy
| | - Jacqueline Palace
- Department Clinical Neurology, Nuffiled Department of Clinical Neurology, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Gregorio Spagni
- Department of Neurosciences, Drugs and Child Health, University of Florence, Italy
| | - Marta Cheli
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milano, Italy
| | - Annabel Ruiter
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Jan Verschuuren
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milano, Italy.
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Chen P, Zhou Q, Zhao X, Chen Y, Lin Z, Wang M, Yang Z, Liu W. Extraocular muscle volume on time-of-flight magnetic resonance angiography in patients with myasthenia gravis. Muscle Nerve 2024; 70:379-386. [PMID: 38948953 DOI: 10.1002/mus.28192] [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: 11/08/2023] [Revised: 06/02/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION/AIMS Despite being a prominent feature of myasthenia gravis (MG), extraocular muscle (EOM) has received little attention in clinical research. The aim of this study was to examine EOM volume in patients with MG and controls using time-of-flight magnetic resonance angiography (TOF-MRA). METHODS EOM volumes (overall and individual rectus muscles) were calculated using TOF-MRA images and compared between MG patients (including subgroups) and controls. The correlation between EOM volume and disease duration was examined. Predictive equations for the selected parameters were developed using multiple linear regression analysis. RESULTS EOM volume was lower in MG patients than controls, especially in MG patients with ophthalmoparesis (MG-O). MG-O exhibited a moderate negative correlation between EOM volume and disease duration. Multiple linear regression showed that disease duration and EOM status (ophthalmoparesis or not) account for 48.4% of EOM volume. DISCUSSION Patients with MG show atrophy of the EOMs, especially those with ophthalmoparesis and long disease duration.
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Affiliation(s)
- Pei Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qin Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxiao Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingqian Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqiang Lin
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Mengzhu Wang
- MR Scientific Marketing, Siemens Healthineers Ltd, Guangzhou, China
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weibin Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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Tavasoli A. Immune mediated myasthenia gravis in children, current concepts and new treatments: A narrative review article. IRANIAN JOURNAL OF CHILD NEUROLOGY 2024; 18:21-42. [PMID: 38988843 PMCID: PMC11231678 DOI: 10.22037/ijcn.v18i3.45054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/19/2024] [Indexed: 07/12/2024]
Abstract
Myasthenia gravis (MG) is the most frequent transmission disease in the neuromuscular junction. Juvenile myasthenia gravis (JMG) is an autoimmune antibody-mediated disease of postsynaptic endplate defined as MG presentation in patients before the age of 18 years old. While many clinical features of JMG are identical to the adults, there are some significant differences between them regarding presentation, clinical course, antibody level, and thymus histopathology. In JMG, ocular symptoms are more frequent, the clinical course is comparably benign, and the outcome is better than adult MG. Antibodies attack the muscle endplate proteins in the postsynaptic membrane and interfere with transmission. These antibodies in most patients are against the acetylcholine receptors, but they may also be directed toward muscle-specific kinase, lipoprotein-related protein 4, and agrin. Findings show racial influences and genetic effects on the occurrence of JMG. The essential clinical symptom is fatigable weakness of muscles that can be in the form of isolated ocular type or more disseminated weakness. The diagnosis of JMG is essentially clinical, with fluctuating patterns of weakness and easy fatigability, but a series of diagnostic evaluations can confirm the diagnosis. Precise diagnostic evaluation and distinction from congenital myasthenic syndromes is critical. The treatment plan is conducted according to the clinical course (ocular or generalized), antibody type, and disease severity. The mainstay of treatment includes symptomatic therapy, long-lasting immunosuppressive treatment and treatment of myasthenic crisis. Novel medications are introduced and conducted to the specific pathophysiologic mechanisms of the disease, and they are used primarily in the refractory MG.
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Affiliation(s)
- Azita Tavasoli
- Department of Pediatric Neurology , Iran University of Medical Sciences, Tehran, Iran
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Kessi M, Tang Y, Chen B, Wang G, Zhang C, He F, Peng J, Yin F, Yang L. Pediatric Ocular Myasthenia Gravis: Single-Center Experience. Pediatr Neurol 2024; 153:137-143. [PMID: 38382246 DOI: 10.1016/j.pediatrneurol.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and timing of treatment for pediatric OMG cases based on the clinical manifestations: OMG with ptosis only and OMG with other features. METHODS One hundred and forty two OMG cases attended at the Department of Pediatrics, Xiangya Hospital, Central South University, from 2010 to 2019 were included, and information from medical records was reviewed and recorded. Comparisons of clinical characteristics between patients with OMG with ptosis only and patients with OMG with other features as well as between patients treated with glucocorticoid (GC) within or after six months from disease onset were performed. RESULTS OMG with other features constituted about 54.9% of the cases, and 66.2% of the patients achieved optimal outcome. Patients with OMG with ptosis only responded to pyridostigmine alone more than patients with OMG with other features who required several therapies (P < 0.001). Patients with OMG with ptosis only had a larger proportion of optimal outcome than the patients with OMG with other features (P = 0.002), and the difference remained significant even when the individual outcome groups were compared (P < 0.001). Patients who received GC within six months had a greater proportion of optimal outcome than those who received it after six months (P < 0.001). CONCLUSIONS Although OMG with other features is a more common subtype of OMG, it is also more severe than OMG with ptosis only. An earlier addition of GC leads to optimal outcome.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yulin Tang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Baiyu Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Guoli Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Ciliu Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China; Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China; Clinical Research Center for Children Neurodevelopmental Disabilities of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.
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Antonioni A, Raho EM, Carlucci D, Sette E, De Gennaro R, Capone JG, Govoni V, Casetta I, Pugliatti M, Granieri E. The Incidence of Myasthenia Gravis in the Province of Ferrara, Italy, in the Period of 2008-2022: An Update on a 40-Year Observation and the Influence of the COVID-19 Pandemic. J Clin Med 2023; 13:236. [PMID: 38202243 PMCID: PMC10780173 DOI: 10.3390/jcm13010236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Myasthenia gravis (MG) is the most common neuromuscular junction disorder. We evaluated the MG incidence rate in the province of Ferrara, Northern Italy, over two time frames (2008-2018 and 2019-2022, i.e., the COVID-19 pandemic) and considered early-onset (EOMG), late-onset (LOMG), and thymoma- and non-thymoma-associated MG. Moreover, in the second period, we assessed its possible relationship with SARS-CoV-2 infection or COVID-19 vaccination. We used a complete enumeration approach to estimate the MG incidence and its temporal trend. For the period of 2008-18, 106 new cases were identified (mean incidence rate 2.7/100,000 people). The highest rates were observed for the over-70 age group and in rural areas, with 17% of thymoma-associated MG. During the COVID-19 period, 29 new cases were identified (average incidence rate 2.1/100,000 people), showing a marked (though not statistically significant) decrease in the mean annual incidence compared to the previous period. Again, the highest rate was observed for the over-70 age group. The first period was in line with our previous observations for the period between 1985 and 2007, highlighting a rising incidence of LOMG and a marked decrease in EOMG. During the COVID-19 period, incidence rates were lower in the first years whereas, when the pandemic ended, the previous trend was confirmed.
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Affiliation(s)
- Annibale Antonioni
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Emanuela Maria Raho
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Domenico Carlucci
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Elisabetta Sette
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Riccardo De Gennaro
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Jay Guido Capone
- Unit of Neurology, Interdistrict Health Care Department of Neurosciences, S. Anna Ferrara University Hospital, 44124 Ferrara, Italy
| | - Vittorio Govoni
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Ilaria Casetta
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Maura Pugliatti
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
| | - Enrico Granieri
- Unit of Neurology, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.A.); (E.M.R.); (I.C.); (M.P.)
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11
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Hayashi M. Pathophysiology of Childhood-Onset Myasthenia: Abnormalities of Neuromuscular Junction and Autoimmunity and Its Background. PATHOPHYSIOLOGY 2023; 30:599-617. [PMID: 38133144 PMCID: PMC10747330 DOI: 10.3390/pathophysiology30040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The pathophysiology of myasthenia gravis (MG) has been largely elucidated over the past half century, and treatment methods have advanced. However, the number of cases of childhood-onset MG is smaller than that of adult MG, and the treatment of childhood-onset MG has continued to be based on research in the adult field. Research on pathophysiology and treatment methods that account for the unique growth and development of children is now desired. According to an epidemiological survey conducted by the Ministry of Health, Labour and Welfare of Japan, the number of patients with MG by age of onset in Japan is high in early childhood. In recent years, MG has been reported from many countries around the world, but the pattern of the number of patients by age of onset differs between East Asia and Western Europe, confirming that the Japanese pattern is common in East Asia. Furthermore, there are racial differences in autoimmune MG and congenital myasthenic syndromes according to immunogenetic background, and their pathophysiology and relationships are gradually becoming clear. In addition, treatment options are also recognized in different regions of the world. In this review article, I will present recent findings focusing on the differences in pathophysiology.
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Affiliation(s)
- Masatoshi Hayashi
- Department of Pediatrics, Uwajima City Hospital, Uwajima 798-8510, Japan
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12
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Liu P, Qi G, Gu S, Dong H, Liu C, Yang H. Single-cell transcriptomics and network pharmacology reveal therapeutic targets of Jianpi Yiqi Bugan Yishen decoction in immune cell subsets of children with myasthenia gravis. Transl Pediatr 2022; 11:1985-2003. [PMID: 36643680 PMCID: PMC9834954 DOI: 10.21037/tp-22-593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is an acquired autoimmune disease of the neuromuscular junction. As immunosuppressive agents used to treat MG have a significant impact on the growth and development of children, treatment is extremely challenging. Jianpi Yiqi Bugan Yishen Decoction (JYBYD) has been developed to treat MG and has achieved satisfactory results in clinical practice. This study aimed to explore its action mechanism and evaluate its active ingredients and potential therapeutic targets. METHODS Single-cell transcriptome sequencing of peripheral blood immune cells of children with MG was performed to reveal the changes in immune cell profiles before and after JYBYD treatment. Lewis rats were included in the model, with classic MG induced by subcutaneous injection of the immunogen acetylcholine receptor (AChR). Twenty rats were divided into two groups and administered normal saline and JYBYD by gavage daily. RESULTS An increase in cell populations characterized by cortactin expression was observed, which has a potential effect on the recovery of lesions at the neuromuscular junction in patients with MG. Based on the differential expression of genes in various immune cells and the predicted targets of traditional Chinese medicine (TCM) compounds, the possible therapeutic targets of JYBYD in different cell subsets were identified, among which STAT1, MCL1, and FOS were the most frequent. Comprehensive network pharmacological analysis suggested quercetin, luteolin, and resveratrol as important active ingredients of JYBYD for the treatment of children with MG. JYBYD could relieve myasthenia symptoms and reduce the AChR-Ab titer in the rat model. Immunohistochemistry results of the muscle showed that JYBYD treatment decreased the expression of STAT1, MCL1, and c-FOS proteins in the muscles of MG rat models. CONCLUSIONS The results of this study are of significance for the clinical application of JYBYD and drug development against MG in children.
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Affiliation(s)
- Peng Liu
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China.,Hebei Provincial Key Laboratory of Myasthenia Gravis, Shijiazhuang, China
| | - Guoyan Qi
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China.,Hebei Provincial Key Laboratory of Myasthenia Gravis, Shijiazhuang, China.,Hebei Provincial Clinical Research Center for Myasthenia Gravis, Shijiazhuang, China
| | - Shanshan Gu
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China.,Hebei Provincial Clinical Research Center for Myasthenia Gravis, Shijiazhuang, China
| | - Huimin Dong
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China
| | - Chaoying Liu
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China.,Hebei Provincial Key Laboratory of Myasthenia Gravis, Shijiazhuang, China
| | - Hongxia Yang
- Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang Affiliated to Hebei Medical University, Shijiazhuang, China
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13
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Heckmann JM. A single low-dose rituximab infusion in severe chronic refractory myasthenia gravis in resource-limited settings. J Neurol Sci 2022; 442:120394. [PMID: 36057244 DOI: 10.1016/j.jns.2022.120394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/19/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
The benefits of multi-dose rituximab cycles in patients with refractory anti-muscle-specific kinase antibody myasthenia gravis (MuSK+MG) are well reported, although less consistently in anti-acetylcholine receptor antibody MG (AChR+MG). Responsivity data to single low-dose rituximab infusions for refractory autoimmune myasthenia, are limited. Here, observational outcomes using MG grading scores and prednisone doses, before and after at least six months of a single-dose infusion of rituximab, were audited in previously treatment-refractory MG patients in a resource-limited setting. Seventeen moderately-severe to severely symptomatic MG patients received single low-dose rituximab infusions (median 500-600 mg) after a median MG duration of 6 years; 13 individuals responded including 5/5 MuSK+MG, 7/10 AChR+MG and 1/2 double seronegative MG. Three (60%) MuSK+MG and three (30%) AChR+MG achieved persistent asymptomatic status. Although more MuSK+MG vs AChR+MG cases stopped prednisone (80% vs 20%, respectively), the prednisone doses in the AChR+MG group was significantly reduced ≥30% (p = 0.008) due to improved MG composite scores (p = 0.016) and with durable benefit (median 12 months). There were no differences between responders and non-responders in MG duration and age at infusion. These results suggest that a single low-dose rituximab infusion is worth trying in refractory MG, including AChR+MG patients, as some patients showed good and durable responses. These results are particularly relevant to resource-limited settings.
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Affiliation(s)
- Jeannine M Heckmann
- Neurology Division, Department of Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
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14
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Ramdas S, Hum RM, Price A, Paul A, Bland J, Burke G, Farrugia M, Palace J, Storrie A, Ho P, Standing E, Lilleker JB, Jungbluth H. SARS-CoV-2 vaccination and new-onset myasthenia gravis: A report of 7 cases and review of the literature. Neuromuscul Disord 2022; 32:785-789. [PMID: 36130855 PMCID: PMC9443923 DOI: 10.1016/j.nmd.2022.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
Myasthenia gravis (MG) is an antibody-mediated immune disorder of the neuromuscular junction. SARS-CoV-2 is now recognised as a trigger factor for autoimmune diseases and to cause immune-mediated dysregulation, likely due to molecular mimicry induced by viral antigens. SARS-CoV-2 vaccination, similarly, results in exposure to viral antigen. Here we report 7 cases of new-onset myasthenia gravis in timely association with SARS-CoV-2 vaccination, including the first paediatric case identified to date. We also reviewed the literature for other new-onset MG cases reported within 4 weeks of SARS-CoV-2 vaccination and discuss our findings in the context of altered (auto)immunity following SARS-CoV-2 vaccination and/or infection.
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Affiliation(s)
- Sithara Ramdas
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, United Kingdom; Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ryan Malcolm Hum
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Abigail Price
- Department of Paediatrics, QEQM Hospital, Margate, United Kingdom
| | - Anna Paul
- Department of Paediatrics, QEQM Hospital, Margate, United Kingdom
| | - Jeremy Bland
- Department of Neurophysiology, East Kent University Hospitals NHS Foundation Trust, Kent, United Kingdom
| | - Georgina Burke
- Wessex Neurological Centre, Southampton General Hospital, Hampshire, United Kingdom
| | - Maria Farrugia
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Alice Storrie
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Ho
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Emma Standing
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - James B Lilleker
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College, London, United Kingdom.
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15
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Raga SV, Wilmshurst JM, Smuts I, Meldau S, Bardien S, Schoonen M, van der Westhuizen FH. A case for genomic medicine in South African paediatric patients with neuromuscular disease. Front Pediatr 2022; 10:1033299. [PMID: 36467485 PMCID: PMC9713312 DOI: 10.3389/fped.2022.1033299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Paediatric neuromuscular diseases are under-recognised and under-diagnosed in Africa, especially those of genetic origin. This may be attributable to various factors, inclusive of socioeconomic barriers, high burden of communicable and non-communicable diseases, resource constraints, lack of expertise in specialised fields and paucity of genetic testing facilities and biobanks in the African population, making access to and interpretation of results more challenging. As new treatments become available that are effective for specific sub-phenotypes, it is even more important to confirm a genetic diagnosis for affected children to be eligible for drug trials and potential treatments. This perspective article aims to create awareness of the major neuromuscular diseases clinically diagnosed in the South African paediatric populations, as well as the current challenges and possible solutions. With this in mind, we introduce a multi-centred research platform (ICGNMD), which aims to address the limited knowledge on NMD aetiology and to improve genetic diagnostic capacities in South African and other African populations.
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Affiliation(s)
- Sharika V Raga
- Department of Neurophysiology, Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jo Madeleine Wilmshurst
- Department of Neurophysiology, Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Izelle Smuts
- Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Surita Meldau
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service and University of Cape Town, Cape Town, South Africa
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town, South Africa
| | - Maryke Schoonen
- Human Metabolomics, North-West University, Potchefstroom, South Africa
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