COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

Shah, Syed Muhammad Ismail; Yasmin, Farah; Memon, Roha Saeed; Jatoi, Nadia Nazir; Savul, Ilma Saleh; Kazmi, Sana; Monawwer, Syed Abdullah; Zafar, Muhammad Daim Bin; Asghar, Muhammad Sohaib; Tahir, Muhammad Junaid; Lee, Ka Yiu

doi:10.1002/brb3.2789

Cited by 14 publications

(15 citation statements)

References 89 publications

(106 reference statements)

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“…(Trinchillo et al, 2023). These findings are also supported by several other studies (Alcantara et al, 2023;Farina et al, 2022;Lupica et al, 2022;Shah et al, 2022).…”

Section: Discussionsupporting

confidence: 87%

Association between COVID‐19 and myasthenia gravis (MG): A genetic correlation and Mendelian randomization study

Sun,

Tu,

Wang

et al. 2023

Brain and Behavior

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Background:Observational studies have suggested an association between coronavirus disease 2019 (COVID‐19) and myasthenia gravis (MG). Here, we aimed to estimate the genetic correlation and causal relationship between COVID‐19 susceptibility, hospitalization, severity, and MG phenotypes using linkage disequilibrium score regression (LDSC) and Mendelian randomization (MR) approach.MethodsSummary statistics of COVID‐19 susceptibility, hospitalization, and severity were used as instrumental variables for exposure traits. Large‐scale genome‐wide association study (GWAS) data for MG were used as outcome traits. The inverse variance weighted approach was used for the main MR analysis, complemented by MR‐Egger, weighted median, simple mode, and weighted mode methods. Sensitivity analysis was implemented using Cochran's Q test, MR‐PRESSO method, and MR‐Egger intercept test.ResultsLDSC analysis did not reveal any genetic correlation among COVID‐19 susceptibility, hospitalization, severity, and MG phenotypes, including MG, early‐onset MG, and late‐onset MG (p > .05). Our MR analysis did not provide evidence supporting a causal effect of COVID‐19 susceptibility, hospitalization, or severity on MG phenotypes (p > .05). Extensive sensitivity analysis strengthened the robustness and consistency of the MR estimates.ConclusionOur study did not find evidence of a genetic correlation or causal relationship among COVID‐19 susceptibility, hospitalization, severity, and MG. Future studies with more GWAS data are needed to evaluate the association between COVID‐19 phenotypes and MG and its subgroups.

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“…(Trinchillo et al, 2023). These findings are also supported by several other studies (Alcantara et al, 2023;Farina et al, 2022;Lupica et al, 2022;Shah et al, 2022).…”

Section: Discussionsupporting

confidence: 87%

Association between COVID‐19 and myasthenia gravis (MG): A genetic correlation and Mendelian randomization study

Sun,

Tu,

Wang

et al. 2023

Brain and Behavior

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“…To the best of our knowledge, previous publications on this topic were based primarily on descriptive reports including single case reports [11–14], case series [14, 16], and systematic reviews [10, 15]. Even though case reports are an important novelty‐detecting tool, they also have limitations, including lack of a control group, small number of patients, limited generalizability, and publication bias [21].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, previous publications on this topic were based primarily on descriptive reports including single case reports [11][12][13][14], case series [14,16], and systematic reviews [10,15].…”

Section: Ta B L Ementioning

confidence: 99%

“…Since the beginning of extensive COVID-19 global vaccination programs, several case reports and case series linking MG onset and MG exacerbations to COVID-19 vaccines have been published [11][12][13][14][15]. Hypothetical explanations for this association include molecular mimicry between SARS-CoV-2 molecules and human antigens, hyperstimulation of the innate immune system, and expression of subclinical latent pre-existing MG [12,15].…”

mentioning

confidence: 99%

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Association between COVID‐19 vaccination and myasthenia gravis: A population‐based, nested case–control study

Arbel

Bishara

Barnett‐Griness

et al. 2023

Euro J of Neurology

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BackgroundExisting data regarding the link between COVID‐19 vaccine and myasthenia gravis (MG) are scarce. We aimed to assess the association between Pfizer‐BioNTech vaccine with both new‐onset MG and MG exacerbation.MethodsFor the first aim, we conducted a nested case‐control study in a cohort of 3,052,467 adults, without a diagnosis of MG, from the largest healthcare provider in Israel. Subjects were followed from January 1, 2021, until June 30, 2022, for the occurrence of MG. Ten randomly selected controls were matched to each case of new‐onset MG on age, and sex. For the second aim, a nested case‐control study was conducted in a cohort of 1,446 MG patients. Four randomly selected MG patients (controls) were matched to each case of MG exacerbation. Exposure to COVID‐19 vaccine in the prior four weeks was assessed in cases and controls.ResultsOverall, 332 patients had new‐onset MG and were matched with 3,320 controls. Multivariable conditional logistic regression models showed that the OR for new‐onset MG, associated with COVID‐19 vaccine, was 1.14 (95% CI, 0.73‐1.78). The results were consistent in sensitivity analysis that used more stringent criteria to define MG. Overall, 62 patients with MG exacerbation were matched to 248 MG controls. The multivariable OR for MG exacerbation, associated with COVID‐19 vaccine, was 1.35 (0.37‐4.89). All results were similar when the prior exposure to COVID‐19 vaccine was extended to 8 weeks.ConclusionsThis study suggests that Pfizer‐BioNTech vaccine is not associated with increased risk of new‐onset nor exacerbation of myasthenia gravis.

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“…A shared characteristic between MG and COVID-19 pathophysiology is cytokine dysregulation. 13 This cytokine dysregulation caused by COVID-19 may accelerate autoimmune responses. Different immune responses to COVID-19 have been reported between adults and children, and immune response in children with COVID-19 is reported to be characterized by lower T-cell activation than in adults.…”

Section: Discussionmentioning

confidence: 99%

A Case of Generalized Myasthenia Gravis Exacerbated by COVID-19

Kanatani

Yamaguchi

Oikawa

et al. 2023

Journal of Pediatric Neurology

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Myasthenia gravis (MG) is a rare, long-term neuromuscular disorder that can affect individuals of any age. In Japan, the Omicron variant of coronavirus disease 2019 (COVID-19) began spreading in 2022, and many cases of neurological symptoms caused by the virus have been reported. Although COVID-19 has been reported to exacerbate MG in adults, there are no reports on the effects of COVID-19 on the MG symptoms of pediatric patients. We report the case of a 6-year-old girl with a 3-year history of MG who presented to our hospital with symptom exacerbation after COVID-19 infection. Four days before admission, she developed fever with a runny nose and cough. Three days before admission, she developed severe bilateral blepharoptosis and progressive limb weakness, and 2 days before admission, she was diagnosed with COVID-19 by SARS-CoV-2 antigen test. Physical examination revealed moderate blepharoptosis and mild bilateral upper and lower limb weakness. We diagnosed her with worsening MG due to COVID-19, and she was administered 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days with continued oral corticosteroids and tacrolimus. The patient's symptoms improved promptly after admission and, at discharge 7 days after admission, her symptoms had significantly improved. During the 1-month outpatient follow-up period, she remained stable and the anti-acetylcholine receptor (AchR) antibody level was reduced to 14.6 nmol/L (from 18.5 nmol/L on admission). Our case suggests that COVID-19 exacerbates MG in both children and adults.

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COVID‐19 and myasthenia gravis: A review of neurological implications of the SARS‐COV‐2

Cited by 14 publications

References 89 publications

Association between COVID‐19 and myasthenia gravis (MG): A genetic correlation and Mendelian randomization study

Association between COVID‐19 and myasthenia gravis (MG): A genetic correlation and Mendelian randomization study

Association between COVID‐19 vaccination and myasthenia gravis: A population‐based, nested case–control study

A Case of Generalized Myasthenia Gravis Exacerbated by COVID-19

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