Myasthenia gravis in Ceará, Brazil: clinical and epidemiological aspects

Aguiar, Aline de Almeida Xavier; Carvalho, André F.; Costa, Carlos Maurício de Castro; Fernandes, José Marcelino Aragão; D'Almeida, José Artur Costa; Furtado, Luís Edmundo Teixeira de Arruda; Cunha, Francisco Marcos Bezerra da

doi:10.1590/s0004-282x2010000600003

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30] Ocular symptoms were the first symptoms described by most MG patients; however, they were not considered the main problem with the disease progression. Bulbar symptoms were considered the most disabling, which is in agreement with some studies.…”

Section: References Discussionmentioning

confidence: 99%

“…There was no significant difference between thymectomized and non-thymectomized patients in clinical parameters which is concordant with other Brazilian reports. 20,29,30 Indeed, several cross-sectional studies failed to find any significant difference between patients who underwent thymectomy and those under conservative treatment. 5,9,12,20,21,24,29 In this scenario and taking into account the risks associated with the surgical procedure, the indication of thymectomy is frequently withheld.…”

Section: References Discussionmentioning

confidence: 99%

“…20,29,30 Indeed, several cross-sectional studies failed to find any significant difference between patients who underwent thymectomy and those under conservative treatment. 5,9,12,20,21,24,29 In this scenario and taking into account the risks associated with the surgical procedure, the indication of thymectomy is frequently withheld. To solve this issue a multi-center, single-blind, randomized study, comparing thymectomy to no thymectomy in MG patients receiving prednisone, is underway (clinicaltrials.…”

Section: References Discussionmentioning

confidence: 99%

“…Conversely, a few Brazilian case series have been reported, describing clinical and sociodemographic features of patients followed at specialized clinics. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] The aim of the current study was to determine the clinical profile of patients with MG under treatment at the Neuromuscular Diseases Clinic of the University Hospital, Federal University of Minas Gerais (UFMG), com-paring it with other series to draw a picture of the MG in Brazil.…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais

Mourão

Barbosa

Comini-Frota

et al. 2015

Rev. Assoc. Med. Bras.

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Section: References Discussionmentioning

confidence: 99%

Section: References Discussionmentioning

confidence: 99%

Section: References Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais

Mourão

Barbosa

Comini-Frota

et al. 2015

Rev. Assoc. Med. Bras.

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“…According to a small cohort study we presented earlier, CMG comprises approximately 50% of all MG cases in the Chinese mainland 3. In other populations, such as among people of European, American, Japanese, or Taiwanese origin, only 10 to 15% of patients with MG develop symptoms before they are 15 years old 5, 6, 7, 8, 9, 10. These apparent discrepancies in the incidence rate imply that the underlying immunopathogenesis mechanisms may be different in different populations.…”

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confidence: 98%

Molecular and clinical relationship between live‐attenuated Japanese encephalitis vaccination and childhood onset myasthenia gravis

Zhang

Xiao

et al. 2018

Annals of Neurology

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ObjectiveThe incidence of childhood onset myasthenia gravis (CMG) in China is higher than that in other countries; however, the reasons for this are unclear.MethodsWe investigated the clinical and immunological profiles of CMG, and assessed the potential precipitating factors. For the mouse studies, the possible implication of vaccination in the pathogenesis was explored.ResultsIn our retrospective study, 51.22% of the 4,219 cases of myasthenia gravis (MG) were of the childhood onset type. The cohort study uncovered that the pathophysiology of CMG was mediated by immune deviation, rather than through gene mutations or virus infections. The administration of the live‐attenuated Japanese encephalitis vaccine (LA‐JEV), but not the inactivated vaccine or other vaccines, in mice induced serum acetylcholine receptor (AChR) antibody production, reduced the AChR density at the endplates, and decreased both muscle strength and response to repetitive nerve stimulation. We found a peptide (containing 7 amino acids) of LA‐JEV similar to the AChR‐α subunit, and immunization with a synthesized protein containing this peptide reproduced the MG‐like phenotype in mice.InterpretationOur results describe the immunological profile of CMG. Immunization with LA‐JEV induced an autoimmune reaction against the AChR through molecular mimicry. These findings might explain the higher occurrence rate of CMG in China, where children are routinely vaccinated with LA‐JEV, compared with that in countries, where this vaccination is not as common. Efforts should be made to optimize immunization strategies and reduce the risk for developing autoimmune disorders among children. Ann Neurol 2018;84:386–400

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Characteristics of late-onset myasthenia gravis

2012

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An increasing incidence of myasthenia gravis (MG) has been reported in the elderly, but the full clinical ramifications of late-onset myasthenia gravis (LOMG) remain unclear. We describe the clinical features of our cohort of patients with MG with an emphasis on an onset after the age of 50. This was a retrospective analysis of medical records of a cohort of patients followed in two tertiary neuromuscular clinics and comparison of early onset MG (EOMG) versus LOMG. There were 174 patients with a mean age of onset of 55.2 ± 19.1 years, and 44 % were women. Late onset of myasthenia gravis after age 50 was reported in 114 patients (66 %). Anti-AChR antibody titers were elevated in 78 % of patients (65 % with EOMG vs. 85 % with LOMG; p = 0.003), and frequency of elevated titers of anti-MuSK antibodies was similar in both groups (present in 38 % of all tested seronegative patients). Myasthenic crisis was equally common in generalized EOMG and LOMG (13 %). Ocular MG was more common in LOMG compared to EOMG (40 vs. 18 %, p = 0.021). Diabetes was more prevalent with LOMG (27 vs. 5 %; p = 0.0002). Overlapping clinical features of EOMG and LOMG are consistent with a continuous clinical spectrum of a single condition, with more frequent occurrence of seropositive and ocular MG with a late onset. A higher burden of comorbidities, such as diabetes mellitus, may warrant a modified approach to treatment of myasthenia in LOMG. However, overall disease severity may not be higher with aging. These observations have implications for design of MG clinical trials and outcomes studies.

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Myasthenia gravis in Ceará, Brazil: clinical and epidemiological aspects

Cited by 14 publications

References 31 publications

Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais

Clinical profile of patients with myasthenia gravis followed at the University Hospital, Federal University of Minas Gerais

Molecular and clinical relationship between live‐attenuated Japanese encephalitis vaccination and childhood onset myasthenia gravis

Characteristics of late-onset myasthenia gravis

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