Clinical Reasoning: Therapeutic considerations in myasthenic crisis due to COVID-19 infection

Hoang, Phuong Mai; Hurtubise, Brigitte; Muppidi, Srikanth

doi:10.1212/wnl.0000000000010651

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Saied Z and colleagues (2021) also described the good outcome of MG patients with COVID-19 who got corticosteroid [ 14 ]. The use of another immunosuppressive (mycophenolate mofetil) or immunomodulatory drug (IVIG or PLEX) in this condition must be considered case-by-case based on the benefit–risk ratio and the consideration of local experts [ 10 , 22 , 49 , 54 ]. Jakubíková and colleagues (2021) reported that immunosuppressant drugs did not affect the worsening of COVID-19 due to the suppression of cytokine storm [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

The relationship between myasthenia gravis and COVID-19: a systematic review

Tugasworo

Kurnianto

Retnaningsih

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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Introduction Viral infection such as coronavirus disease 2019 (COVID-19) can exacerbate and aggravate neurological disorders due to autoimmune etiology like myasthenia gravis (MG). Experimental therapies used in COVID-19 are also factors that can cause the worsening of MG symptoms. This review aimed to assess and conclude the research-based study systematically to analyze the relationship of MG and COVID-19. Method This study was conducted in accordance to Cochrane handbook for systematic reviews and the guideline of preferred reporting items for systematic review and meta-analysis (PRISMA) and synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. Inclusion criteria in this review were primary studies of every design, articles published in English around January 2000–October 2021, and the study used human as subject. A systematic literature finding was applied in 15 electronic scientific resources. The authors evaluated the study quality and risk of bias of each retrieved article. Results The authors found the study through electronic scientific resources that met inclusion and exclusion criteria. The authors evaluated 362 articles identified in literature searching, 22 articles met the criteria for this review and then underwent the evaluation of study quality and risk of bias. Conclusion COVID-19 infection can increase the risk of new-onset MG, myasthenic crisis, respiratory failure, and mortality rate due to cytokine storm in MG patients. The management of COVID-19 patients with MG is tailored to each person and based on national guidelines and local expert recommendations.

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Section: Discussionmentioning

confidence: 99%

The relationship between myasthenia gravis and COVID-19: a systematic review

Tugasworo

Kurnianto

Retnaningsih

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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“…However, the populations in these studies were too low (n = 5 and 1, respectively) to reveal any conclusive evidence. The treatment options in COVID-19-provoked MG worsening include symptomatic, immunosuppression, and immunomodulation; however, treatment choice is very important in this regard [67]. Immunosuppression has been found to offer better therapeutic outcomes [25].…”

Section: Covid-19 In Myasthenia Gravismentioning

confidence: 99%

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

et al. 2021

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The unremitting coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked a year-long phase of public health adversaries and has severely compromised healthcare globally. Early evidence of COVID-19 noted its impact on the pulmonary and cardiovascular functions, while multiple studies in recent time shed light on its substantial neurological complications, though a comprehensive understanding of the cause(s), the mechanism(s), and their neuropathological outcomes is scarce. In the present review, we conferred evidence of neurological complications in COVID-19 patients and shed light on the SARS-CoV-2 infection routes including the hematogenous, direct/neuronal, lymphatic tissue or cerebrospinal fluid, or infiltration through infected immune cells, while the underlying mechanism of SARS-CoV-2 invasion to the central nervous system (CNS) was also discussed. In an up-to-date manner, we further reviewed the impact of COVID-19 in developing diverse neurologic manifestations associated with CNS, peripheral nervous system (PNS), skeletal muscle, and also pre-existing neurological diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, and myasthenia gravis. Furthermore, we discussed the involvement of key factors including age, sex, comorbidity, and disease severity in exacerbating the neurologic manifestations in COVID-19 patients. An outlook of present therapeutic strategies and state of existing challenges in COVID-19 management was also accessed. Conclusively, the present report provides a comprehensive review of COVID-19-related neurological complications and emphasizes the need for their early clinical management in the ongoing COVID-19 pandemic. Keywords COVID-19 • SARS-CoV-2 • CNS • PNS • Neuroinvasion • COVID-19 pandemic • Neurological complications Highlights• Coronavirus disease 2019 (COVID-19)-associated complications involve substantial neurological manifestations.• SARS-CoV-2 infection routes include the hematogenous, neuronal, lymphatic tissue/cerebrospinal fluid, or infiltration through infected immune cells.• COVID-19 promotes neurologic manifestations associated with the central and peripheral nervous system and exacerbates the pre-existing neurological and neurodegenerative conditions. • Patient's age, sex, comorbidity, and severity of the infection are key factors that determine the extent of neurologic manifestations in COVID-19 patients.

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“…The current state of knowledge on the interaction between MG and COVID-19 is changing rapidly due to growing experience in patients. The ongoing international registry launched by Muppidi et al will surely provide informations useful for the care of MG patients during this pandemic [74][75][76].…”

Section: Discussionmentioning

confidence: 99%

Myasthenia gravis at the crossroad of COVID-19: focus on immunological and respiratory interplay

Galassi¹,

Marchioni

2021

Acta Neurol Belg

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Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus (SARS-CoV-2) has become a global pandemic threat. COVID-19 caused by SARS-CoV-2 is reported to originate in December 2019 in Wuhan, China and spreading rapidly around world. SARS-CoV-2 is structurally similar to the other coronaviruses, causing the severe respiratory syndrome (SARS-CoV) and the middle east respiratory syndrome (MERS-CoV), both binding to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. ACE 2 is widely expressed in several cells including, neural tissue. COVID-19 presents with fever and respiratory symptoms, possibly leading to acute respiratory distress (ARDS) but there are several published reports of acute cerebrovascular diseases, seizures, olfactory and gustatory dysfunctions, isolated involvement of cranial nerves, myositis/rabdhomyolisis as well myasthenic crisis (MC) and Guillain–Barré syndrome (GBS). The ARDS described during COVID-19 pandemic, coupled with respiratory muscle failure occurring in myasthenia gravis (MG), may result in a life-threatening condition, challenging for intensivists, pulmonologists and neurologists. Infections are recognized trigger of exacerbations and crisis in MG and patients with MG probably exhibit a mortality higher than the general population during this COVID-19 pandemic. We review the current state of knowledge on MG during the COVID-19 pandemic to focus the immunological and respiratory interplay between these two conditions.

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Clinical Reasoning: Therapeutic considerations in myasthenic crisis due to COVID-19 infection

Cited by 10 publications

References 11 publications

The relationship between myasthenia gravis and COVID-19: a systematic review

The relationship between myasthenia gravis and COVID-19: a systematic review

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

Myasthenia gravis at the crossroad of COVID-19: focus on immunological and respiratory interplay

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