Marathons and myasthenia gravis: a case report

Abstract

BackgroundThe cardinal symptoms of auto-immune myasthenia gravis are fatigue and weakness. Endurance events such as marathon running would seem incompatible with this chronic disease. Many patients stop sport altogether. There is limited literature of patients with auto-immune myasthenia gravis undergoing regular endurance exercise.Case presentationWe report the case of a 36-year-old female who began long-distance running whilst experiencing initial symptoms of myasthenia gravis. She was diagnosed with auto-immune myasthenia gravis and whilst advised to stop all sport, her way of fighting and living with this chronic and unpredictable disease was to continue running to maintain a healthy body and mind. Despite suffering from ocular, bulbar and localized limb fatigability, she managed to complete multiple marathons and achieve disease stability with cholinesterase inhibitors.ConclusionsMarathon and half-marathon running lead to distinct changes in mediators of inflammation in an exercise-dose-dependent manner. Despite symptoms of weakness and fatigue in certain muscles in myasthenia gravis, physical exertion remains possible and may not worsen symptoms as demonstrated in this case and recent studies. The immunomodulatory role of exercise could be considered in this case however this hypothesis remains to be confirmed in future studies with quantitative data.

Physical training and exercise in myasthenia gravis

“…This is in line with the minimum recommended for elderly healthy adults [33]. Single patients with generalized MG and AChR antibodies that have successfully completed both several marathons and ultramarathons have been reported [34,35], further supporting the safety of exercise in MG.…”

Myasthenia Gravis and Physical Exercise: A Novel Paradigm

“…There is a paucity of information on MG patients and sports participation and no clear guidelines for athletes with MG (7,63,64). To our knowledge, four case reports exist on athletes with MG and are summarized in Table 2.…”

Exercise Training for autoimmune myasthenia gravis: A review of safety and effectiveness based on existing literature

“…Although few studies explicitly focused on safety and not all studies reported AEs, an important finding from this review, from precedent reviews and published case reports, 13,[38][39][40] is that there is no data to support exercise as a harmful intervention in MG. Only four studies explicitly stated that participants had stable disease. There is no study to date demonstrating evidence of an exercise-related myasthenic crisis.…”

“…Exercise could also counter possible corticotherapy-induced myopathy and osteoporosis from long-term corticosteroid use. Further, exercise could play an immunomodulatory role in MG. 13 In addition, unlike many pharmacological agents, exercise has minimal, if any, side effects when adapted to the individual.…”