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Lehnerer S, Herdick M, Stegherr R, Gerischer L, Stascheit F, Stein M, Mergenthaler P, Hoffmann S, Meisel A. Burden of disease in Lambert-Eaton myasthenic syndrome: taking the patient's perspective. J Neurol 2024; 271:2824-2839. [PMID: 38421419 PMCID: PMC11055781 DOI: 10.1007/s00415-024-12206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune-mediated neuromuscular disorder leading to muscle weakness, autonomic dysregulation and hyporeflexia. Psychosocial well-being is affected. Previously, we assessed burden of disease for Myasthenia gravis (MG). Here, we aim to elucidate burden of disease by comparing health-related quality of life (HRQoL) of patients with LEMS to the general population (genP) as well as MG patients. METHODS A questionnaire-based survey included sociodemographic and clinical data along with standardized questionnaires, e.g. the Short Form Health (SF-36). HRQoL was evaluated through matched-pairs analyses. Participants from a general health survey served as control group. RESULTS 46 LEMS patients matched by age and gender were compared to 92 controls from the genP and a matched cohort of 92 MG patients. LEMS participants showed lower levels of physical functioning (SF-36 mean 34.2 SD 28.6) compared to genP (mean 78.6 SD 21.1) and MG patients (mean 61.3 SD 31.8). LEMS patients showed lower mental health sub-scores compared to genP (SF-36 mean 62.7 SD 20.2, vs. 75.7 SD 15.1) and MG patients (SF-36 mean 62.7 SD 20.2, vs. 66.0 SD 18.). Depression, anxiety and fatigue were prevalent. Female gender, low income, lower activities of daily living, symptoms of depression, anxiety and fatigue were associated with a lower HRQoL in LEMS. DISCUSSION HRQoL is lower in patients with LEMS compared to genP and MG in a matched pair-analysis. The burden of LEMS includes economic and social aspects as well as emotional well-being. TRIAL REGISTRATION INFORMATION: drks.de: DRKS00024527, submitted: February 02, 2021, https://drks.de/search/en/trial/DRKS00024527 .
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Affiliation(s)
- Sophie Lehnerer
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany.
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Digital Health Center, Charitéplatz 1, 10117, Berlin, Germany.
| | - Meret Herdick
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Regina Stegherr
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lea Gerischer
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Digital Health Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Frauke Stascheit
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Maike Stein
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Digital Health Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Mergenthaler
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Hoffmann
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology With Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Neuroscience Clinical Research Center, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Dewilde S, Phillips G, Paci S, De Ruyck F, Tollenaar NH, Janssen MF. The Burden Patients with Myasthenia Gravis Experience in Terms of Breathing, Fatigue, Sleep, Mental Health, Discomfort and Usual Activities in Comparison to the General Population. Adv Ther 2024; 41:271-291. [PMID: 37921955 PMCID: PMC10796601 DOI: 10.1007/s12325-023-02704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Myasthenia gravis (MG) is a rare neuromuscular disorder marked by a variable combination of weakness of eye, bulbar, respiratory, axial, and limb muscles. This study compared the experience of people with MG regarding breathing, fatigue, sleep, pain/discomfort, mental health, and usual activities with the general population. METHODS The MyRealWorld-MG digital, multinational study enrolled patients with MG and collected demographics, PROMIS-Dyspnea, PROMIS-Sleep Disturbance, FACIT-Fatigue, EQ-5D-5L, Health Utilities Index (HUI-3), Hospital Anxiety and Depression Scale (HADS), MG-Activities of Daily Living (MG-ADL), and MG-Quality-of-Life (MG-QoL-15r). Comparisons with the general population were based on PROMIS population norms, published literature, or on data from a digital, multinational, observational study which enrolled a representative sample of the general population (POPUP). RESULTS In MyRealWorld-MG (N = 2074), patients experienced higher intensity, frequency, and duration of PROMIS shortness of breath than a US population (p < 0.0001). Patients with MG had higher PROMIS-Sleep Disturbance scores than POPUP (53.7 vs 50.0, p < 0.0001), and 54.9% of patients had clinically severe FACIT-Fatigue scores vs 6.8% in POPUP (p < 0.0001). Among patients with MG, 69.6% and 18.5% had moderate-to-severe HADS-Anxiety and HADS-Depression compared to 20.3% and 6.9% in POPUP (p < 0.001). Statistically significant and strong associations were found between fatigue, sleep, dyspnea, usual activities, and emotions. All outcomes worsened with more severe disease. CONCLUSION A considerable burden was observed in this comparison of breathing, sleep, fatigue, mental health, and usual activities between patients with MG and the general population, using data from two international studies and published population norms. Even mildly affected patients had significantly worse outcomes than the general population.
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Affiliation(s)
- S Dewilde
- Services in Health Economics (SHE), Rue JG Eggerickx 36, 1150, Woluwe, Brussels, Belgium.
| | | | - S Paci
- argenx BV, Ghent, Belgium
| | | | - N H Tollenaar
- Services in Health Economics (SHE), Rue JG Eggerickx 36, 1150, Woluwe, Brussels, Belgium
| | - M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
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Xu RH, Yu S, Liu J, Zhang S, Dong D. Developing the health state classification system for a condition-specific preference-based measure for patients with myasthenia gravis. Disabil Rehabil 2023; 45:3366-3372. [PMID: 36102606 DOI: 10.1080/09638288.2022.2120096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to generate the health state classification system (HCS) of a condition-specific preference-based measure to capture the health-related quality of life (HRQoL) of patients with myasthenia gravis (MG) from the 15-item Myasthenia Gravis Quality of Life Scale (MG-QoL15r). MATERIALS AND METHODS An HCS was derived from the MG-QoL15r in a large sample of 1739 patients with MG based on psychometric analysis, including factor analysis, item response theory analysis, and discussions with experts. Reliability, construct and convergent validity, and item fit of the HCS were further assessed using another sample. RESULTS The HCS has six dimensions: social activity, hobbies and fun activities, meeting family needs, work performance, mobility, and emotion, and it demonstrates good internal consistency reliability. The unidimensionality of the HCS was confirmed using confirmatory factor analysis. Satisfied convergent validity was supported by a significant association with the 12-item Short Form Survey (SF-12). CONCLUSIONS Based on a solid process of development and consultations with clinical professionals and patients, a valid MG-specific preference-based measure, MGQoL-6D, was developed. Further research will estimate the local preference weight to support the MG-related cost-utility analysis.IMPLICATION FOR REHABILITATIONA new condition-specific health state classification system (HCS) named Myasthenia gravis Quality of Life Scale (MGQoL-6D) is proposed.MGQoL-6D classifies MG health states as a combination of six dimensions with three response levels.The dimensions of the HCS are social activity, hobbies and fun activity, family needs, work performance, mobility, and emotion.The HCS and the upcoming value set of the MGQoL-6D could support the cost-effectiveness analysis of MG-related clinical and rehabilitated interventions.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ji Liu
- Beijing Aili Myasthenia Gravis Care Center, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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Lehnerer S, Jacobi J, Schilling R, Grittner U, Marbin D, Gerischer L, Stascheit F, Krause M, Hoffmann S, Meisel A. Burden of disease in myasthenia gravis: taking the patient's perspective. J Neurol 2022; 269:3050-3063. [PMID: 34800167 PMCID: PMC9120127 DOI: 10.1007/s00415-021-10891-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) leads to exertion-dependent muscle weakness, but also psychological and social well-being are limited. We aim to describe the burden of disease in MG including sociodemographic, economical, psychosocial as well as clinical aspects, to compare health-related quality of life (HRQoL) of patients with MG to the general population (genP) and to explore risk factors for a lower HRQoL. METHODS This case-control study was conducted with MG patients of the German Myasthenia Association. A questionnaire-based survey included sociodemographic and clinical data as well as standardized questionnaires, e.g. the Short Form Health (SF-36). HRQoL was compared to genP in a matched-pairs analysis. Participants of the German Health Interview and Examination Survey for Adults (DEGS1) served as control group. RESULTS In our study, 1660 MG patients participated and were compared to 2556 controls from the genP. Patients with MG showed lower levels of physical functioning (SF-36 mean 56.0, SD 30.3) compared to the genP (mean 81.8, SD 22.1, adjusted difference: 25, 95% CI 22-29) and lower mental health sub-score (SF-36 mean 67.3, SD 19.8, vs. 74.1, SD 16.7, adjusted difference: 5, 95% CI 2-8). Female gender, higher age, low income, partnership status, lower activities of daily life, symptoms of depression, anxiety and fatigue and self-perceived low social support were associated with a lower HRQoL in MG patients. DISCUSSION HRQoL is lower in patients with MG compared to genP. The burden of MG on patients includes economic and social aspects as well as their emotional well-being. New therapies must achieve improvements for patients in these areas. TRIAL REGISTRATION INFORMATION Clinicaltrials.gov, NCT03979521, submitted: June 7, 2019, first patient enrolled: May 1, 2019, https://clinicaltrials.gov/ct2/show/NCT03979521.
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Affiliation(s)
- Sophie Lehnerer
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Jonas Jacobi
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ralph Schilling
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Luisenstraße 57, 10117, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Core Facility Genomics, Berlin Institute of Health at Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Derin Marbin
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Charité University Medicine Berlin at St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| | - Lea Gerischer
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frauke Stascheit
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maike Krause
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Hoffmann
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology with Experimental Neurology, Charité University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Howard JF, Karam C, Yountz M, O’Brien FL, Mozaffar T. Long-term efficacy of eculizumab in refractory generalized myasthenia gravis: responder analyses. Ann Clin Transl Neurol 2021; 8:1398-1407. [PMID: 34043280 PMCID: PMC8283175 DOI: 10.1002/acn3.51376] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Generalized myasthenia gravis (gMG) is an autoimmune disease that causes disabling weakness via damage to the neuromuscular junction. In most patients, the disease is mediated by autoantibodies to the acetylcholine receptor, which activate the complement cascade. Our objective was to analyze response profiles in adult patients with anti-acetylcholine receptor antibody-positive refractory gMG treated with eculizumab-a terminal complement inhibitor-in the REGAIN study or its open-label extension (OLE). METHODS We retrospectively analyzed Myasthenia Gravis-Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores recorded during REGAIN and its OLE. Early/late responses were defined as improvement in MG-ADL score (≥3 points) or QMG score (≥5 points) at ≤12 or >12 weeks, respectively, after eculizumab initiation. RESULTS The analysis included 98 patients. By Week 12 and conclusion of the OLE, MG-ADL response had been achieved at some point by 67.3% and 84.7% of patients, respectively, and QMG response by 56.1% and 71.4%, respectively. Response was observed over multiple consecutive assessments for most patients. At Week 130, the least-squares mean percentage changes (95% CI) from baseline in MG-ADL score were -61.9% (-69.9%, -53.9%) and -47.5% (-59.0%, -36.0%) in early and late MG-ADL responders, respectively; the least-squares mean percentage changes from baseline in QMG score were -40.8% (-48.3%, -33.4%) and -55.5% (-68.4%, -42.7%) in early and late QMG responders, respectively. INTERPRETATION The findings suggest that, although most patients with refractory gMG will achieve clinical response by Week 12 of eculizumab treatment, first responses can be observed with longer-term treatment.
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Affiliation(s)
- James F. Howard
- Department of NeurologyThe University of North CarolinaChapel HillNorth CarolinaUSA
| | - Chafic Karam
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Present address:
Penn Neuroscience Center ‐ Neurology, Hospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | | | - Tahseen Mozaffar
- Department of NeurologyUniversity of CaliforniaIrvineCaliforniaUSA
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Abstract
This cross-sectional study aimed to assess the impact of epilepsy, myasthenia gravis (MG), and multiple sclerosis (MS) on pregnancy and family planning decision-making in a cohort of Saudi women. Women with epilepsy, MG, and MS were recruited consecutively at the time of their follow-up visits at a neurology clinic. Data were collected using 3 standardized questionnaires, and presented using descriptive statistics. A logistic regression was performed to determine variables associated with decisions regarding abstaining from pregnancy and encouraging other women to conceive. A total of 272 (83 epilepsy, 69 MG, and 120 MS) women with a mean age of 29.9 ± 8.0 years participated. The proportion of women who abstained from or postponed pregnancy was 41.2% and 31.4%, respectively. The concerns mentioned most often were disease worsening during pregnancy, peripartum and postpartum, side effects of medications on the unborn child, and inability to care for the child. Older age was independently associated with the decision to abstain from pregnancy (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04 - 1.25). Higher knowledge levels were independently associated with encouraging other women to have children (OR 1.3, 95% CI 1.11-1.53). Over 50% of women reported that they were not counseled on issues related to pregnancy and childbirth. In conclusion, we identified a major influence of epilepsy, MG, and MS on pregnancy and family planning. Comprehensive counseling programs are needed to help women with these neurological diseases make informed family-planning decisions.
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Affiliation(s)
| | - Alanood Asiri
- Department of Internal Medicine, College of Medicine, King Saud University
| | - Maha F. Edrees
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh
| | - Ahmad R. Abuzinadah
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal medicine department, Neurology Division, Jeddah, Saudi Arabia
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Miao XH, Lian ZY, Liu J, Chen HX, Shi ZY, Zhou HY, Yang R. [Investigation and analysis of health-related quality of life in myasthenia gravis patients with myasthenia gravis quality of life-15 Chinese version]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:514-520. [PMID: 29930422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the level and influencing factors of health-related quality of life in myasthenia gravis (MG) patients with myasthenia gravis quality of life-15 (MGQOL-15) Chinese version and to provide corresponding measures in one tertiary hospital of Sichuan Province. METHODS We collected the general data (gender, age, body mass index BMI, marital status, educational level and employee status), clinical data [Osserman type, myasthenia gravis composite (MGC), other immunopathies, disease duration, frequency of outpatient visits per month, ratio of disease cost to income each month and frequency of symptoms during the past month] and the MGQOL-15 Chinese version from 168 myasthenia gravis patients in one tertiary hospital of Sichuan Province. RESULTS The mean score of MGQOL-15 was 17.67±12.78. The score of the item "My occupational skills and job status have been negatively affected." was the highest, followed by "I have trouble using my eyes." and "I am frustrated by my MG." Single factor analysis showed that MG patients' QOL were different with different disease severity MGC (F=19.353, P<0.001), ratio of disease cost to income each month (F=5.831, P<0.001) and the frequency of symptoms during the past month (F=9.128,P<0.001). Multiple regression analysis showed that disease severity MGC (β=0.743,P<0.001), ration of disease cost to income each month (β=3.347,P<0.001) and the frequency of symptoms during the past month (β=2.216,P<0.003) were the main predictors of HRQOL in the MG patients. CONCLUSION Our study showed that the MGQOL-15 is helpful for clinicians to evaluate MG patients' QOL regularly, investigate the influencing factors and implement corresponding interventions the so as to improve the patients' quality of life. Disease severity MGC, ratio of disease cost to income each month and the frequency of symptoms during the past month were the main predictors of MG patients' QOL. Clinicians should pay more attention to MG patients' disease severity MGC and the frequency of symptoms during the past month.
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Affiliation(s)
- X H Miao
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - Z Y Lian
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Liu
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - H X Chen
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - Z Y Shi
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - H Y Zhou
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
| | - R Yang
- Department of Neurology,West China Hospital, Sichuan University, Chengdu 610041, China
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Nagane Y, Murai H, Imai T, Yamamoto D, Tsuda E, Minami N, Suzuki Y, Kanai T, Uzawa A, Kawaguchi N, Masuda M, Konno S, Suzuki H, Aoki M, Utsugisawa K. Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study. BMJ Open 2017; 7:e013278. [PMID: 28235967 PMCID: PMC5337722 DOI: 10.1136/bmjopen-2016-013278] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To clarify the social disadvantages associated with myasthenia gravis (MG) and examine associations with its disease and treatment. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We evaluated 917 consecutive cases of established MG seen at 13 neurological centres in Japan over a short duration. OUTCOME MEASURES All patients completed a questionnaire on social disadvantages resulting from MG and its treatment and a 15-item MG-specific quality of life scale at study entry. Clinical severity at the worst condition was graded according to the MG Foundation of America classification, and that at the current condition was determined according to the quantitative MG score and MG composite. Maximum dose and duration of dose ≥20 mg/day of oral prednisolone during the disease course were obtained from the patients' medical records. Achievement of the treatment target (minimal manifestation status with prednisolone at ≤5 mg/day) was determined at 1, 2 and 4 years after starting treatment and at study entry. RESULTS We found that 27.2% of the patients had experienced unemployment, 4.1% had been unwillingly transferred and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was ≥50% of their previous total income. In addition, 49.0% of the patients reported feeling reduced social positivity. Factors promoting social disadvantages were severity of illness, dose and duration of prednisolone, long-term treatment, and a depressive state and change in appearance after treatment with oral steroids. Early achievement of the treatment target was a major inhibiting factor. CONCLUSIONS Patients with MG often experience unemployment, unwilling job transfers and a decrease in income. In addition, many patients report feeling reduced social positivity. To inhibit the social disadvantages associated with MG and its treatment, greater focus needs to be placed on helping patients with MG resume a normal lifestyle as soon as possible by achieving the treatment target.
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Affiliation(s)
- Yuriko Nagane
- Department of Neurology, Hanamaki General Hospital, Hanamaki, Japan
| | - Hiroyuki Murai
- Department of Neurological Therapeutics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomihiro Imai
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Daisuke Yamamoto
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Emiko Tsuda
- Department of Neurology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Naoya Minami
- Department of Neurology, Hokkaido Medical Center, Sapporo, Japan
| | - Yasushi Suzuki
- Department of Neurology, Sendai Medical Center, Sendai, Japan
| | - Tetsuya Kanai
- Department of Neurology, Chiba University School of Medicine, Chiba, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Chiba University School of Medicine, Chiba, Japan
| | | | - Masayuki Masuda
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Shingo Konno
- Department of Neurology, Toho University Oh-hashi Medical Center, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Neurology, Kinki University School of Medicine, Osaka, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Burns TM, Sadjadi R, Utsugisawa K, Gwathmey KG, Joshi A, Jones S, Bril V, Barnett C, Guptill JT, Sanders DB, Hobson-Webb L, Juel VC, Massey J, Gable KL, Silvestri NJ, Wolfe G, Cutter G, Nagane Y, Murai H, Masuda M, Farrugia ME, Carmichael C, Birnbaum S, Hogrel JY, Nafissi S, Fatehi F, Ou C, Liu W, Conaway M. International clinimetric evaluation of the MG-QOL15, resulting in slight revision and subsequent validation of the MG-QOL15r. Muscle Nerve 2016; 54:1015-1022. [PMID: 27220659 DOI: 10.1002/mus.25198] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The MG-QOL15 is a validated, health-related quality of life (HRQOL) measure for myasthenia gravis (MG). Widespread use of the scale gave us the opportunity to further analyze its clinimetric properties. METHODS We first performed Rasch analysis on >1,300 15-item Myasthenia Gravis Quality of Life scale (MG-QOL15) completed surveys. Results were discussed during a conference call with specialists and biostatisticians. We decided to revise 3 items and prospectively evaluate the revised scale (MG-QOL15r) using either 3, 4, or 5 responses. Rasch analysis was then performed on >1,300 MG-QOL15r scales. RESULTS The MGQOL15r performed slightly better than the MG-QOL15. The 3-response option MG-QOL15r demonstrated better clinimetric properties than the 4- or 5-option scales. Relative distributions of item and person location estimates showed good coverage of disease severity. CONCLUSIONS The MG-QOL15r is now the preferred HRQOL instrument for MG because of improved clinimetrics and ease of use. This revision does not negate previous studies or interpretations of results using the MG-QOL15. Muscle Nerve 54: 1015-1022, 2016.
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Affiliation(s)
- Ted M Burns
- University of Virginia, Department of Neurology, Charlottesville, Virginia, 22908, USA
| | - Reza Sadjadi
- University of Rochester, Rochester, New York, USA
| | | | - Kelly G Gwathmey
- University of Virginia, Department of Neurology, Charlottesville, Virginia, 22908, USA
| | - Amruta Joshi
- University of Virginia, Department of Neurology, Charlottesville, Virginia, 22908, USA
| | - Sarah Jones
- University of Virginia, Department of Neurology, Charlottesville, Virginia, 22908, USA
| | - Vera Bril
- Toronto General Hospital, Toronto, Canada
| | | | | | | | | | - Vern C Juel
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Gil Wolfe
- University at Buffalo, SUNY Buffalo, New York, USA
| | - Gary Cutter
- University of Alabama, Birmingham, Birmingham, Alabama, USA
| | | | - Hiroyuki Murai
- Neurological Institute, Kyushu University, Fukuoka, Japan
| | | | - Maria Elena Farrugia
- Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Caroline Carmichael
- Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | | | | | - Shahriar Nafissi
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Changyi Ou
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, PRC, China
| | - Weibin Liu
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, PRC, China
| | - Mark Conaway
- University of Virginia, Department of Neurology, Charlottesville, Virginia, 22908, USA
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Mourão AM, Gomez RS, Barbosa LSM, da Silva Freitas D, Comini-Frota ER, Kummer A, Lemos SMA, Teixeira AL. Determinants of quality of life in Brazilian patients with myasthenia gravis. Clinics (Sao Paulo) 2016; 71:370-4. [PMID: 27464292 PMCID: PMC4946526 DOI: 10.6061/clinics/2016(07)03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aims of the current study were 1) to evaluate the reliability and validity of the Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale and 2) to investigate the quality of life of Brazilian patients with myasthenia gravis and its determinants. METHODS This cross-sectional study included 69 patients with myasthenia gravis who underwent neurological evaluation and completed questionnaires regarding quality of life (the 36-item Short Form of the Medical Outcomes Study and the 15-item Myasthenia Gravis Quality of Life Scale), anxiety and depressive symptoms. RESULTS The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale showed high internal consistency and good concurrent validity with the 36-item Short Form of the Medical Outcomes Study and its subscales. Determinants of quality of life in Brazilian patients with myasthenia gravis included the current status of myasthenia gravis as assessed by the Myasthenia Gravis Composite, the current prednisone dose and the levels of anxiety and depression. CONCLUSION The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale is a valid instrument. Symptom severity, prednisone dosage and anxiety and depression levels impact the quality of life of patients with myasthenia gravis.
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Affiliation(s)
- Aline Mansueto Mourão
- Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular
- Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil
| | - Rodrigo Santiago Gomez
- Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular
| | - Luiz Sergio Mageste Barbosa
- Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular
| | - Denise da Silva Freitas
- Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular
| | | | - Arthur Kummer
- Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil
| | | | - Antonio Lucio Teixeira
- Universidade Federal de Minas Gerais (UFMG), Hospital Universitário, Unidade de Neurologia, Clinica Neuromuscular
- Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte/MG, Brazil
- E-mail:
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Zou J, Su C, Lun X, Liu W, Yang W, Zhong B, Zhu H, Lei Y, Luo H, Chen Z. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy: A CONSORT Study. Medicine (Baltimore) 2016; 95:e2828. [PMID: 26962777 PMCID: PMC4998858 DOI: 10.1097/md.0000000000002828] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC-especially preoperative anxiety-before performing a thymectomy in patients with MG.
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Affiliation(s)
- Jianyong Zou
- From the Department of Thoracic Surgery, the First Affiliated Hospital (JZ, CS, HZ, YL, HL, ZC); Lung Cancer Research Center (JZ, CS, XL, WY, HZ, YL, HL, ZC); Department of Cardiothoracic Surgery of East Division, the First Affiliated Hospital (XL, WY, ZC); Department of Neurology, the First Affiliated Hospital (WL); and Department of Thoracic Surgery, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China (BZ)
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Koopman WJ, LeBlanc N, Fowler S, Nicolle MW, Hulley D. Hope, Coping, and Quality of Life in Adults with Myasthenia Gravis. Can J Neurosci Nurs 2016; 38:56-64. [PMID: 27468602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Myasthenia gravis significantly impacts quality of life. However, the relationship between hope, coping, and quality of life (QOL)in myasthenia patients has not been studied (Kulkantrakorn & Jarungkiatkul, 2009; Raggi et al., 2010). OBJECTIVE The aim of this study was to explore the relationship between hope, coping, and quality of life in adults with myasthenia gravis. DATA COLLECTION Subjects with MG (n = 100) completed six questionnaires, including a demographic profile, the Myasthenia Gravis Activities of Daily Living Scale (MG-ADL), Herth Hope Index (HHI), Jalowiec Coping Scale (JCS), Myasthenia Gravis Quality-of-Life Scale (MG-QOL15), and Short Form Health Survey (SF-36v2). RESULTS Mean hope scores indicated a high level of hope. An optimistic coping style was the most common and effective coping strategy identified by subjects. Positive thinking and humour were also frequently used strategies. Participants identified quality of life as good tolerability, above general population mental well-being, and below general populationphysical well-being. Participants who identified good quality of life had low scores on the MG-QOL15 scale and high scores on the SF36v2. Hope and independence for activities of daily living were found to correlate with improved quality of life and mental well-being(p < 0.001). Age and length of illness were not significant factors. There was no mediation by well-being or quality of life in the relationship between hope and coping. Hope and coping were not important factors for well-being or quality of life. CONCLUSION Nurses caring for adults with myasthenia gravis should use interventions that continue to support hope, quality of life, and coping throughout the unpredictable and chronic course of MG.
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Nagane Y, Utsugisawa K. [Quality of life and advice for lifestyle in myasthenia gravis]. Nihon Rinsho 2015; 73 Suppl 7:539-545. [PMID: 26480756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Burns TM. More than meets the eye: the benefits of listening closely to what our patients with myasthenia gravis are telling us. Muscle Nerve 2012; 46:153-4. [PMID: 22806362 DOI: 10.1002/mus.23461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Qiu L, Feng HY, Huang X, Mo R, Ou CY, Luo CM, Li Y, Liu WB. [Study of incidence and correlation factors of depression, anxiety and insomnia in patients with myasthenia gravis]. Zhonghua Yi Xue Za Zhi 2010; 90:3176-3179. [PMID: 21223762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate the incidence rate and correlation factors of depression, anxiety and insomnia in patients with myasthenia gravis (MG). METHODS A total of 161 MG patients were assessed and graded with HAMD, HAMA, PSQI, QMG, ADL and a self-made scale chart. And the correlation factors were analyzed by Logistic stepwise regression. RESULTS The prevalence of depression, anxiety and insomnia was 58.3%, 45.3% and 39.1% respectively. The correlation factors with significant influences on MG were as follows: depression with age, physical weakness, score of QMG, life scale grading; anxiety with experience-sharing; insomnia age, dyspnea, thymoma, physical status at 1 month post-operation, prednisone dose and score of QMG. CONCLUSION Nearly one half of the MG patients suffer from affective disorders to different degrees. And an analysis of its correlation factors provides references to prevent and treat the affective disorders concurrently with MG.
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Affiliation(s)
- Li Qiu
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
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Twork S, Wiesmeth S, Klewer J, Pöhlau D, Kugler J. Quality of life and life circumstances in German myasthenia gravis patients. Health Qual Life Outcomes 2010; 8:129. [PMID: 21070628 PMCID: PMC2994799 DOI: 10.1186/1477-7525-8-129] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 11/11/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is a chronic neuromuscular disease. Advances in medical therapy have continuously increased the life expectancy of MG patients, without definitively curing the disease. To analyze life circumstances and quality of life (QoL), a large German MG cohort was investigated. METHODS AND SAMPLE In cooperation with the German Myasthenia Association, 2,150 patients with confirmed MG were asked to respond to a mailed questionnaire. The standardized questions related to demographic data, impairments, therapeutic course, use of complementary therapies, illness-related costs, and quality of life (SF-36). In total, 1,518 patients participated, yielding a response rate of 70.6%. The average age was 56.7 years, and the proportion of females 58.6%. RESULTS Despite receiving recommended therapy, many patients still suffered from MG-related impairments. In particular, mobility and mental well-being were reduced; moreover, quality of life was markedly reduced. Stepwise linear regression analysis revealed illness stability, impairments, mental conditions, comorbid diseases, and employment to be determinants of QoL. CONCLUSION Results indicate that despite prolonged life expectancy among MG patients, health-related quality of life is low. This outcome resulted mainly from impaired mobility and depression. Physical and mental well-being might be improved by additional therapy options. Additionally, health care resources could be used more efficiently in these patients.
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Affiliation(s)
- Sabine Twork
- Department of Health Sciences/Public Health, Faculty of Medicine "Carl Gustav Carus" at the University of Technology Dresden, Germany
| | - Susanne Wiesmeth
- Department of Health Sciences/Public Health, Faculty of Medicine "Carl Gustav Carus" at the University of Technology Dresden, Germany
| | - Jörg Klewer
- Department of Health Sciences/Public Health, Faculty of Medicine "Carl Gustav Carus" at the University of Technology Dresden, Germany
| | - Dieter Pöhlau
- Department of Neurology, Kamillus-Hospital, Asbach, Germany
| | - Joachim Kugler
- Department of Health Sciences/Public Health, Faculty of Medicine "Carl Gustav Carus" at the University of Technology Dresden, Germany
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Kulkantrakorn K, Jarungkiatkul W. Quality of life of myasthenia gravis patients. J Med Assoc Thai 2010; 93:1167-1171. [PMID: 20973319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate the impact of myasthenia gravis (MG) on the quality of life (QOL) of MG patients. MATERIAL AND METHOD QOL was assessed with SF-36 questionnaire. RESULTS Thirty-one patients participating in the present study, 74.2% female, with an average age of 44.9 years old. From the SF-36 questionnaire, emotional well being had the lowest score while other components were in average or high range. Ocular and mild generalized MG had better physical functioning than moderate generalized MG With treatment, those who had no or minimal symptoms had better QOL in both physical and mental aspects. Immunosuppressant was not associated with poor QOL. CONCLUSION QOL of Thai MG patients is better than Westerners. However, MG still has significant impact to both physical and mental aspects. More emphasis is needed for mental aspects. The degree of disease control is very important in QOL and the use of immunosuppressant does not impair QOL.
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Affiliation(s)
- Kongkiat Kulkantrakorn
- Neurology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumtani, Thailand.
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Kawabe K, Ikeda K, Yoshii Y, Iwasaki Y. Cognition in patients with myasthenia gravis. Muscle Nerve 2010; 42:148; author reply 148-9. [PMID: 20544932 DOI: 10.1002/mus.21677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chen XL, Liu FB, Guo L, Liu XB. [Development of patient-reported outcome scale for myasthenia gravis: a psychometric test]. Zhong Xi Yi Jie He Xue Bao 2010; 8:121-125. [PMID: 20141733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the scientificity of patient-reported outcome (PRO) scale for myasthenia gravis (MG), which was used to evaluate the clinical effects of traditional Chinese and Western medicine treatment on MG patients. Psychometric performance of the MG-PRO scale was also expected to be evaluated in this study. METHODS A total of 100 MG patients and 100 healthy people were face-to-face interviewed by well-trained investigators, and the data of MG-PRO scale were collected. The classical theory test (CTT) and item response theory (IRT) methods were used to analyze the psychometric performance such as validity, reliability, person separation index (PSI) and differential item functioning (DIF) in the MG-PRO scale. RESULTS The results of CTT analysis showed that the split-half reliabilities of the MG-PRO scale and each dimension were greater than 0.7. In the analysis of internal consistency of each dimension, the Cronbach's alpha was greater than 0.8. Each facet had greater correlation with its dimension than the other dimensions. Four principal components were extracted by exploratory factor analysis, which represented all dimensions of the scale, and the cumulative variance was 55.54%. The scores of each of the 8 facets between MG patients and healthy people were different (P<0.01). The results of IRT showed that the PSI of each model was greater than 0.8, and all items did not have uniform DIF and non-uniform DIF. CONCLUSION The MG-PRO scale reflects the definition and connotation of quality of life and contains special issues of MG patients as well, and shows good reliability (split-half reliability, Cronbach's alpha), validity (content validity, construct validity, discriminate validity) from the results of CTT, and good psychometric performance from the results of IRT.
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Affiliation(s)
- Xin-lin Chen
- Department of Preventive Medicine and Health Statistics, College of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510407, Guangdong Province, China
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Abstract
Myasthenia gravis patients usually present with fluctuating, asymmetrical stress-dependent weakness in the absence of other neurological disturbances. In weak patients psychopathological disturbances are frequently reported and misdiagnosed as a psychiatric disorder. The question to what extent psychiatric symptoms are involved in MG is still open. The case report presented here shows exemplary that psychopathological disturbances in exacerbated myasthenic patients are temporary and completely reversible after adequate somatic therapy.
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Affiliation(s)
- Wolfgang Köhler
- Dept. of Neurology and Neurological Intensive Care, Fachkrankenhaus Hubertusburg, 04779, Wermsdorf, Germany.
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Grigor'eva VN, Ruin VA. [The influence of psychic stress on the clinical manifestations and course of myasthenia gravis]. Zh Nevrol Psikhiatr Im S S Korsakova 2007; 107:17-25. [PMID: 18379483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An aim of the study was to evaluate whether psychic stress influenced clinical manifestations and course severity in patients with myasthenia gravis (MG). Seventy-three patients with proven MG (mean age 36,6; SD 13,7 years) and 112 healthy controls (mean age 38,3; SD 10,3 years) were included in the study. The Myasthenia Symptoms Severity Scale was specially elaborated for MG symptoms quantitative assessment. Pneumotachimetric pulmonary functions, including forced expiratory volume in 1 sec (FEV1) and psychological characteristics (short version of MMPI test, Spilberger Anxiety Inventory, Zung Self-Rating Depression Scale (SDS), were measured in each patient. The main causes of daily stress by means of a special self-questionnaire were ascertained and assessment of disability severity was scored. The first examination (T1) was followed up by a second one (T2) 12 months later. In each patient, disease course was specified as mild, moderate or very severe during the T1-T2 period. In most patients (60%), the development or decompensation of MG was caused by psychogenic stressors. Reactive and personal anxiety as well as SDS index were higher in patients as compared to healthy subjects (p<0,001). There was no association between any of personality traits and MG but the patient's average personality profile was elevated comparing to the control group that suggested a presence of mild chronic stress. The main causes of daily stress were related to the consequences of MG. Reactive anxiety was correlated with myasthenia symptoms severity scores and disability scores in patients (p<0,05). The prognostic significance for severe MG course was estimated for the myasthenia symptoms severity score, reactive anxiety (more than 55 scores) and FEV1. The results obtained suggest that psychotherapy seems to be most useful for patients with severe myasthenia symptoms and high psychic stress.
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Abstract
Here we report how the different types of regional muscle involvement, i.e. bulbar, ocular or generalized, in patients with myasthenia gravis (MG) influence the mental aspects of quality of life. Clinical examination according to Osserman was performed in 48 MG patients (45 women, three men; mean age 54, SD 12 years). Each patient was at the time for clinical evaluation asked to fill out the disease-specific Myasthenia Gravis Questionnaire (MGQ) and the Short-Form 36-item questionnaire for health survey (SF-36) as patient-oriented tools. We related the regional domains (generalized domain, bulbar domain and ocular domain) of the MGQ and the clinical findings, respectively, with mental quality of life as assessed by SF-36. Bulbar and generalized involvement results in impairment of mental aspects of quality of life, whereas ocular involvement does not.
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Affiliation(s)
- A Rostedt
- Department of Clinical Neurophysiology, University Hospital, Uppsala, Sweden.
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Rostedt A, Padua L, Stålberg EV. Correlation between a patient-derived functional questionnaire and abnormal neuromuscular transmission in Myasthenia Gravis patients. Clin Neurophysiol 2005; 116:2058-64. [PMID: 16043394 DOI: 10.1016/j.clinph.2005.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 05/12/2005] [Accepted: 05/21/2005] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To correlate the patient-derived physical function score, as measured by the disease specific Myasthenia Gravis Questionnaire (MGQ), and the score obtained with commonly used generic 36-item questionnaire, the Short-Form health survey (SF-36), with the degree of abnormal neuromuscular transmission measured by Single-Fibre EMG (SFEMG) and repetitive nerve stimulation (RNS) in Myasthenia Gravis (MG) patients. METHODS SFEMG and RNS were performed in the deltoid muscle and SFEMG was also performed in the orbicularis oculi muscle in 45 MG patients. The patients were asked to fill out the MGQ, which has been translated and validated into Swedish, and the SF-36. The sum of MGQ items generates a global MGQ score. Items are also divided into 3 muscle specific domains: generalized, bulbar and ocular. RESULTS The global MGQ score and generalized domain score of MGQ were strongly correlated with the degree of abnormal neuromuscular transmission, as measured by SFEMG in the deltoid muscle. Scores from ocular and bulbar domains of MGQ were not related to neurophysiological findings. Physical composite scores of SF-36 correlated significantly with the abnormal SFEMG findings in the deltoid. CONCLUSIONS The degree of disturbed neuromuscular transmission in a proximal limb muscle correlates with a patient's subjective experience of generalized myasthenic dysfunction. SIGNIFICANCE The observed correlation adds a new dimension to neurophysiological examinations in patients with MG.
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Affiliation(s)
- Anna Rostedt
- Department of Clinical Neurophysiology, University Hospital, S-75185 Uppsala, Sweden.
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Padua L, Galassi G, Ariatti A, Aprile I, Caliandro P, Evoli A, Pazzaglia C, Tonali P. Myasthenia gravis self-administered questionnaire: development of regional domains. Neurol Sci 2005; 25:331-6. [PMID: 15729496 DOI: 10.1007/s10072-004-0366-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 12/17/2004] [Indexed: 10/25/2022]
Abstract
The objective was to develop regional domains from the Myasthenia Gravis Questionnaire (MGQ) to better assess generalised, bulbar and ocular involvement in patients with myasthenia gravis (MG) and to evaluate their responsiveness. Some items from the MGQ were aggregated into 3 domains: bulbar, generalised and ocular. The study was carried out at the Institute of Neurology, EMG Service, Universita Cattolica, Rome, and the Department of Neurology, University Hospital, Modena, Italy. Ninety-three MG patients were prospectively enrolled in two neurological departments; furthermore, outcome after treatment was studied in 23 patients to evaluate responsiveness. Disease severity was scored according to a modified version of the Osserman classification and MGQ. The questionnaire appeared more sensitive than clinical examination and history to assess bulbar and ocular involvement. For example, according to the bulbar domain, 67 patients experienced bulbar symptoms whereas on clinical examination 51 of 67 were completely normal in the bulbar region. The MGQ domains appeared reliable and sensitive. Results of global MG score (GMG) and of domains appeared reliable. Domains were able to better assess the functional involvement of anatomical regions than main GMG, clinical examination and history.
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Affiliation(s)
- L Padua
- Institute of Neurology, Università Cattolica, L.go F. Vito 1, I-00168, Rome, Italy.
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26
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Abstract
BACKGROUND Myasthenia gravis (MG) is a neuromuscular disease sometimes associated with severe psychiatric complications. The use of electroconvulsive therapy (ECT) in MG raises certain challenges. METHODS We describe a patient with MG and a steroid-induced major depressive episode with psychotic features treated with ECT. We also review the literature on similar cases and on the safety of ECT with muscle relaxation in this condition. RESULTS The use of ECT in patients with MG is a viable therapeutic option when psychiatric complications secondary to MG or its treatment do not respond to psychotropic medications. CONCLUSION ECT with muscle relaxants could be administered safely, with appropriate precautions kept in mind.
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Affiliation(s)
- Chadi A Calarge
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Department of Psychiatry, Iowa city, Iowa 52242-1057, USA.
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27
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Abstract
OBJECTIVES Recent reports have led to the hypothesis of a central nervous system involvement in myasthenia gravis (MG). As the central cholinergic system also plays an important role in sleep/wake rhythms and in the regulation of REM sleep, sleep perception and dreaming may be altered in MG patients. PATIENTS AND METHODS Seventeen consecutive patients with MG (mean age 49.5 +/- 13.6 years) and 14 healthy controls (mean age 50.5 +/- 16.0 years) were investigated by means of the Self-Rating Depression Scale, Self-Rating Anxiety Scale, Quality of Life Index, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale as well as a self-rating questionnaire for sleep and awakening quality and dreaming for 2 weeks. RESULTS Subjective sleep and awakening quality and sleep efficiency were reduced (p < 0.05), and the number of nocturnal awakenings (p = 0.02) as well as dream recall frequency (p = 0.02) were increased in patients with MG. Patients reported more often body-related and tactile sensations during dreaming (p = 0.001) and dreamed less often visually (p = 0.04). Dream content, emotions, and dream sources did not differ between both groups. Whereas the number of awakenings was related to dream recall frequency in healthy controls, no such a relationship was found in the patient group. CONCLUSION There is no clear evidence for the arousal-retrieval model of dream recall in patients with MG, but more for the continuity hypothesis of dreaming. Other factors such as the functional state of the brain, possibly related to a central cholinergic involvement in MG or its anticholinesterase treatment, may be important in explaining dream recall in this patient group.
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Affiliation(s)
- Svenja Happe
- Department of Clinical Neurology, University of Vienna, Vienna, Austria.
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28
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Abstract
Using a perceptual technique it is shown that patients with chronic external ophthalmoplegia have shortened vestibular responses. It is postulated that this is secondary to the retinal image slip experienced by these patients during head movements and a useful compensatory mechanism to suppress motion-induced sickness and spatial disorientation.
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Affiliation(s)
- E A Grunfeld
- Psychology Unit, King's College London, Guy's Hospital, UK
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30
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Abstract
We examined ratings of fatigue and cognitive performance in myasthenia gravis (MG) patients and healthy subjects. All participants were administered self-report measures of mental and physical fatigue before and after completing a demanding cognitive work battery. Change in fatigue indices was recorded and examined in relation to cognitive function. Results of the study revealed that baseline ratings of fatigue did not relate to cognitive performances for either group. By contrast, increased mental fatigue from the baseline to the post-test assessment correlated with cognitive measures for patients but not control subjects. MG patients reported that physical fatigue also increased following the work battery, but only ratings of mental fatigue correlated with cognitive performances. The results indicate that cognitive impairments may be associated with perceived fatigue in MG.
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Affiliation(s)
- Robert H Paul
- Department of Psychiatry and Human Behavior, Brown Medical School, Miriam Hospital, Providence, RI, 02906, USA.
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31
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Padua L, Evoli A, Aprile I, Caliandro P, Mazza S, Padua R, Tonali P. Health-related quality of life in patients with myasthenia gravis and the relationship between patient-oriented assessment and conventional measurements. Neurol Sci 2001; 22:363-9. [PMID: 11917973 DOI: 10.1007/s100720100066] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We assessed the health-related quality of life (HRQoL) of patients with myasthenia gravis (MG) and correlated it with the physician's measurements of MG. Patients with MG were evaluated by means of (1) self-administered questionnaires, (2) clinical examination, (3) Osserman classification, (4) anti-AChR antibody, and (5) neurophysiology. Relationships between patient-oriented assessment and conventional clinical-neurophysiological and serological findings were evaluated. A total of 46 patients, inpatients and outpatients (mean age 50.7 years, range 11-77 years, 17 males, 29 females) with MG diagnosis were studied. The Osserman scale and clinical examination findings were significantly related to the physical aspects of HRQoL. Mental aspects of the quality of life were not progressively involved as muscle deficit progressed, but even in a mild clinical picture, the mental aspects were deteriorated. Patient-oriented measures proved that the patient's quality of life was impaired especially with regard to physical aspects. Our data demonstrated that clinical measurements are related to the HRQoL. The results may be useful in developing a disease-specific patient-oriented tool.
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Affiliation(s)
- L Padua
- Institute of Neurology, Cattolic University, Rome, Italy
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33
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Affiliation(s)
- P J Lombroso
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA.
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34
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35
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Abstract
The mood, self-evaluative, and vegetative symptoms of depression in myasthenia gravis were assessed. The frequency of depression was significantly elevated only when assessed by measuring vegetative symptoms. These findings suggest that mood in neuroimmune disorders should be assessed with scales that separate the different dimensions of depression.
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36
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Paul RH, Cohen RA, Zawacki T, Gilchrist JM, Aloia MS. What have we learned about cognition in myasthenia gravis?: a review of methods and results. Neurosci Biobehav Rev 2001; 25:75-81. [PMID: 11166079 DOI: 10.1016/s0149-7634(00)00052-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most individuals with myasthenia gravis (MG) complain of cognitive impairment, but empirical studies of cognition in MG have produced mixed results. In the present review, we critically examined the methodology and results of previous studies that investigated cognition in MG. Results from our review revealed that none of the studies met at least 50% of criteria under review. The most common shortcomings of previous studies included small sample size, no exclusion for visual difficulties in patients, inadequate assessment of mood, and poor control for prednisone use. Despite these methodological difficulties, mild impairments on measures of learning have been identified. These findings need to be replicated with adequate control of potential confounds before any conclusions can be made regarding cognition in this disease. Suggestions for design of future studies are provided.
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Affiliation(s)
- R H Paul
- Miriam Hospital, Brown Medical School, Fain 328, Division of Behavioral and Preventive Medicine, 164 Summit Ave, Providence, RI 20906, USA.
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37
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Abstract
We have examined fatigue in myasthenia gravis (MG) by administering a measure of cognitive and physical fatigue to patients and control subjects before and after administration of a lengthy cognitive battery. Subjects also completed a scale that assessed the impact of fatigue on physical, social, and cognitive function. Results of the study revealed that MG patients experience significantly more cognitive and physical fatigue than do control subjects, and the patients' perceptions of both cognitive and physical fatigue increased significantly following completion of demanding cognitive work. Control subjects reported no significant change in fatigue. Furthermore, MG patients reported that fatigue produced mild to moderate effects on cognitive and social function and moderate effects on physical function. Results from this study indicate that cognitive fatigue is an important symptom of MG and that fatigue produces pervasive impairments in important aspects of patients' lives. Additional studies are needed to understand the neurobehavioral determinants of cognitive fatigue in this population.
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Affiliation(s)
- R H Paul
- Department of Psychiatry, Division of Neuropsychology, Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island 02906, USA.
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38
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Coton X, Ansseau M, Parent M, Jadot M, Ernotte D. [A case of myasthenia gravis diagnosed as conversion disorder]. Rev Med Liege 1999; 54:722-4. [PMID: 10589266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Conversion disorder is a difficult diagnosis. The patients' psychiatric backgrounds and the complexity of the diagnosis of some neurologic diseases are the main reasons for diagnostic errors. Based on one observation, the diagnostic criteria and the differential diagnosis of conversion disorder are addressed.
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Affiliation(s)
- X Coton
- Université de Liège, Service de Psychiatrie et de Psychologie Médicale
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39
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Moberg L. [Passion and suffering of Hjalmar Gullberg]. Lakartidningen 1998; 95:5871-7. [PMID: 9889510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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40
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Glücker H, Nix WA, Willenberg H, Hoffmann SO. [Coping with illness in myasthenia gravis in comparison with other chronic neuromuscular diseases]. Nervenarzt 1998; 69:858-63. [PMID: 9834474 DOI: 10.1007/s001150050354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Seventy-nine patients with chronic neuromuscular diseases were examined by psychodiagnostic tests. The most frequently used coping strategies were "compliance and confidence in the physician", "self encouragement", "to relative by comparison" and "problem-solving". Comparison of the test sample and our total sampling group and the groups divided by diagnosis showed more common features than differences in the coping process. This might be caused by similar general problems in chronic diseases. Less "compliance and confidence in the physician" was the only significant difference between the myasthenic patients and the remaining test group. We supposed less treatment possibilities and/or longer duration of illness (remaining test group) to be responsible for this result. Duration of illness in common seems to have an influence on coping. Patients suffering a longer illness showed reduced values in "self encouragement". Common and specific problems and circumstances of illness seem to be more significant for the coping process than the diagnosis. The patients' mood, which we took as a measure for partial aspects of adaptivity of coping, correlated significantly with the strength of the complaints felt. Classification into adaptive and maladaptive coping forms is not possible.
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Affiliation(s)
- H Glücker
- Klinik und Poliklinik für Neurologie, Universitätskliniken, Mainz
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41
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Fotiou F, Goulas A, Fountoulakis K, Koutlas E, Hamlatzis P, Papakostopoulos D. Changes in psychophysiological processing of vision in myasthenia gravis. Int J Psychophysiol 1998; 29:303-10. [PMID: 9666383 DOI: 10.1016/s0167-8760(98)00005-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the possibility of impaired central nervous system (CNS) cholinergic transmission in myasthenia gravis (MG), and the effect of eye movements and particularly of micromovements in the psychophysiology of vision. MATERIALS AND METHODS Fourteen patients with clinical manifestations of external ophthalmoplegia due to different causes (nine patients with myasthenia gravis and five with ocular myopathy) were examined. Simultaneous recording of eye movements (optical method) and pattern reversal-visual evoked potentials (PR-VEPs) were performed. RESULTS Eye micromovements during fixation were impaired in both groups. A statistically significant difference (P < 0.01) was found in the amplitude of P100 of PR-VEPs before and after treatment in MG patients, and also between normal controls and MG patients before (P < 0.001) and after treatment (P < 0.01). P100 latency of the PR-VEPs in MG patients before and after treatment was delayed compared to normal controls, while there were no differences between ocular myopathy patients and normal controls. CONCLUSION The eye movement impairment observed in MG patients is not sufficient to explain abnormal PR-VEPs detected in these patients. These results provide neurophysiological evidence of impaired cholinergic transmission in the central nervous system in patients with MG and suggest that PR-VEPs offer an easily applicable non-invasive method to study the central effects of MG.
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Affiliation(s)
- F Fotiou
- 1st Neurological Clinic, Lab of Clinical Neurophysiology, General Hospital AHEPA, Aristotle University of Thessaloniki, Greece
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42
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Abstract
Fatigue is the most frequently reported symptom by myasthenia gravis (MG)patients. Despite the prevalence of fatigue, treatment protocols are lacking, thus patients are left to self-manage. The purpose of this study was to describe self-care actions used to manage fatigue among patients with MG. A national sample (N = 250) of MG patients responded to two structured instruments. The Fatigue Survey (FS), modified with permission of authors Hubsky and Sears; and the Myasthenia Gravis Fatigue Scale (MGFS). Both instruments were based on the concept of fatigue. Participants identified three major categories of self-managed actions: mental interventions (76%), physical interventions (78%) and rest/sleep (80%). A subset of the respondents (N = 36) reported using aerobic exercise to attempt to relieve fatigue which is usually contradicted with MG. No significant difference in fatigue scores was found between those reporting aerobic exercise to be helpful and those not finding exercise helpful. However, those utilizing aerobic exercise reported the highest functional status categories. A question arises as to whether aerobic exercise is performed by the least ill MG patients, or aerobic exercise improves functional status. When demographic and functional status variables were associated with fatigue scores and selfcare actions, only gender and functional status were significantly correlated with fatigue score. Effective self-care actions include stress reduction techniques, pacing all activities and increased rest and sleep. Further investigation into the role of aerobic exercise is indicated as a self-care action for MG fatigue.
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Knieling J, Weiss H, Faller H, Lang H, Schalke B, Toyka K. [Follow-up of myasthenia gravis. Results of a longitudinal study of the significance of psychosocial predictors]. Nervenarzt 1998; 69:137-44. [PMID: 9551458 DOI: 10.1007/s001150050250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Forty-two patients suffering from myasthenia gravis were examined in a longitudinal study design. The aim of the study was to investigate possible psychosocial predictors for the course of the disease. At the time of the first examination (T1) the diagnosis myasthenia gravis had been established for no longer than 1 year. Two further examinations were done at 6 months (T2) and 18 months (T3) after T1. Methods consisted of a personality questionnaire (FPI), a coping questionnaire (FKV), an assessment of neurotic symptoms by interviewers (PSKB) and an assessment of the doctor-patient relationship by the attending physicians. Two different severity scores (Oosterhuis Index, Myasthenia Score) served as criteria for the course of the disease. There was no connection between the course of myasthenia gravis and neurotic symptoms like anxiety or depression and the quality of the doctor-patient relationship (both assessed at T1). Also demographic data were independent from the development of severity scores. The personality factor extraversion was associated with a positive course of the disease, aggressiveness and worrying about health with a negative one. Among the coping behaviors religiousness and looking for sense were associated with a favorable course but that was shown only regarding the Oosterhuis Index and not the Myasthenia Score. As several T1 personality factors were predictive for the severity scores at T3, these results may suggest a causal influence of personality factors on the severity of the illness. Whether or not this relationship is actually in operation, however, remains ellusive. Further studies using an experimental design are needed to strengthen this hypothesis.
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Affiliation(s)
- J Knieling
- Institut für Psychotherapie und Medizinische Psychologie, Universität, Würzburg
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44
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45
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Banez ME. Responding effectively to the angry patient. Medsurg Nurs 1996; 5:461-3, 468. [PMID: 9136401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M E Banez
- University of Pennsylvania, Philadelphia, PA, USA
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46
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Glennerster A, Palace J, Warburton D, Oxbury S, Newsom-Davis J. Memory in myasthenia gravis: neuropsychological tests of central cholinergic function before and after effective immunologic treatment. Neurology 1996; 46:1138-42. [PMID: 8780106 DOI: 10.1212/wnl.46.4.1138] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
There are reports of central cholinergic deficits in myasthenia gravis (MG) describing impaired performance on a variety of tests of memory with varying benefits from plasmapheresis. We tested 11 patients with symptomatic MG at the start of a trial of immunosuppressive treatment (prednisolone plus azathioprine or placebo) and again when in remission. The tests included the Logical Memory and Design Reproduction parts of the Wechsler Memory Scale, the Rey Auditory Verbal Learning Test, Peterson-Peterson task, and an auditory vigilance task. Muscle strength improved significantly over the period of treatment, but overall performance on tests of memory or attention did not. These results fail to substantiate reports of functionally significant and reversible central deficits in myasthenia gravis.
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Affiliation(s)
- A Glennerster
- Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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47
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Knieling J, Weiss H, Faller H, Lang H. [Psychosocial causal attributions by myasthenia gravis patients. A longitudinal study of the significance of subjective illness theories after diagnosis and in follow-up]. Psychother Psychosom Med Psychol 1995; 45:373-80. [PMID: 8577912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The present study evaluates the impact of subjective theories of illness in patients suffering from Myasthenia gravis. 46 inpatients were examined after the diagnosis had been made (T1) and 6 months later (T2). The following instruments have been used: a semistructured interview, the ¿Freiburg Personality Inventory¿ (FPI), the ¿Freiburg Questionnaire of Coping with Illness (FKV) and a questionnaire for the judgement of body experiences (FBK). Ratings concerning neurotic symptoms (PSKB), mechanisms of defence (KBAM) and the doctor-patient-relationship were made by the interviewers and the treating neurologist as well. 35% of the patients experienced a connection between psychosocial factors (stress) and the onset of the disease. As compared with those patients not showing a psychosocial causal attribution there are no differences in somatic (type and severity of the disease, thymus histology), but in psychological variables. Patients attributing their disease to psychosocial factors prove to be more depressive, insecure and excitable at T1. They are more likely to be women. These findings are in accordance with the results of previous studies. However, 6 months later (T2) there is some evidence of a psychological stabilization of those patients using psychosocial attributions, as different instruments show concurrently. Partially they appear now even less depressive. This result is understood as a hint for the significance of emotional factors for the process of coping with the disease: patients using a psychosocial explanation concept may appear more vulnerable at an early stage of the disease. But perhaps, by this more emotionally centered coping process, they can reach stability which is connected with the construction of a psychosocial theory of the disease.
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Affiliation(s)
- J Knieling
- Institut für Psychotherapie und Medizinische Psychologie, Universität Würzburg
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[From the other side of the mirror]. Enferm Intensiva 1995; 6:91-2. [PMID: 7493284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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49
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Abstract
Neuropsychological test performance, including memory, and affect were investigated in 16 patients with myasthenia gravis (MG) and in a matched control group. Clinical electroencephalograms (EEGs) were recorded from MG patients. Cognitive measures included the Randt Memory Test and a number of tests from the computerized Neurobehavioral Evaluation Battery which included a test of motor speed. Affect was assessed by means of an anxiety questionnaire (IPAT) and a computer based questionnaire similar to the Profile of Mood States (POMS). There were no significant intergroup differences in memory performance and only an isolated significant finding in a timed measure in symbol-digit comparison. The MG group revealed significantly reduced finger tapping. Significantly higher levels of anxiety, tension, anger, fatigue and confusion were associated with the MG group. Abnormal EEGs occurred in 35% of the MG patients, mostly mid-moderate diffuse slowing, but in one case epileptogenic activity was present. The failure to confirm memory deficits in this study appeared not to be related to age or whether patients had generalized or ocular MG. Medication was suggested as a possible factor. These, and other variables, need to be evaluated in further studies.
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Affiliation(s)
- P R Bartel
- Department of Neurology, University of Pretoria, South Africa
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50
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