Exacerbation of myasthenia gravis during the menstrual period

Leker, Ronen R.; Karni, Arnon; Abramsky, Oded

doi:10.1016/s0022-510x(98)00031-8

Cited by 30 publications

(12 citation statements)

References 13 publications

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“…75 This may become so severe that it is necessary to block menstrual periods by long-acting progesterone, 161 to eliminate recurrent myasthenic crises during menstrual periods.…”

Section: General Treatment Measuresmentioning

confidence: 99%

Clinical evaluation and management of myasthenia gravis

2004

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Myasthenia gravis (MG) is a syndrome of fluctuating skeletal muscle weakness that worsens with use and improves with rest. Eye, facial, oropharyngeal, axial, and limb muscles may be involved in varying combinations and degrees of severity. Its etiology is heterogeneous, divided initially between those rare congenital myasthenic syndromes, which are genetic, and the bulk of MG, which is acquired and autoimmune. The autoimmune conditions are divided in turn between those that possess measurable serum acetylcholine receptor (AChR) antibodies and a smaller group that does not. The latter group includes those MG patients who have serum antibodies to muscle-specific tyrosine kinase (MuSK). Therapeutic considerations differ for early-onset MG, late-onset MG, and MG associated with the presence of a thymoma. Most MG patients can be treated effectively, but there is still a need for more specific immunological approaches.

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“…75 This may become so severe that it is necessary to block menstrual periods by long-acting progesterone, 161 to eliminate recurrent myasthenic crises during menstrual periods.…”

Section: General Treatment Measuresmentioning

confidence: 99%

Clinical evaluation and management of myasthenia gravis

2004

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“…According to some reports MG tends to improve before and during menstruation, while others have shown it to worsen during this time ( Vijayan et al ., 1977 ). A recent survey conducted among myasthenic patients in Israel demonstrated a tendency towards exacerbation in myasthenic symptoms immediately before and during the menstrual period ( Leker et al ., 1998 ). We conducted this study in order to elucidate the exact role of sex hormones in the pathogenesis of exacerbation in experimental autoimmune MG (EAMG), an animal model for MG.…”

Section: Introductionmentioning

confidence: 99%

Effects of sex hormones on experimental autoimmune myasthenia gravis

Leker

Karni

Brenner

et al. 2000

Euro J of Neurology

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To examine whether exacerbation of myasthenia gravis (MG) can be induced by changes in sex hormone levels we immunized 20 female Lewis rats with torpedo antigen to induce experimental autoimmune MG (EAMG). Ten of the animals underwent surgical ovariectomy prior to the induction of EAMG and 10 served as controls. Anti-acetylcholine receptor antibody (AChR-ab) titres and the degree of decrement on repetitive stimulation electromyography (REMG) at 3 Hz were obtained at base line and compared between rats with and without ovariectomy and a second control group of naïve rats. Three rats in each group were then injected with excess oestrogen and progesterone for one week, and three of the remaining rats in each group were given sham injections, and the degree of decrement on REMG and AchR-ab titres were re-evaluated. Immune reactivity of peripheral lymphocytes and splenic lymphocytes from all groups and controls was also determined. A comparable number of animals with and without ovariectomy developed clinical and electromyographic EAMG. The extent of decrement on REMG and AChR-ab titres did not change following hormonal replacement. Lymphocyte reactivity was similar for rats with and without ovariectomy. In conclusion, sex hormones do not appear to have an influence on the susceptibility to and the severity of MG.

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“…Some reports have shown a tendency for MG to improve before and during menstruation, whereas others have shown a worsening during this same time (16). A prospective study showed that MG frequently exacerbates before and during the menstrual period in 67% of patients (5). The exacerbation of symptoms usually starts shortly before the menstrual bleeding and continues well into the menstrual period itself.…”

Section: Discussionmentioning

confidence: 99%

“…The higher prevalence in young women was supposed to represent an effect of sex steroid hormones (3,4). Moreover, in myasthenic women, fluctuations in symptomatology have been reported during menstruation and pregnancy (5,6), supporting the hypothesis that estrogen, progesterone, and other hormones could modulate disease activity (7).…”

mentioning

confidence: 94%