Patients with Parkinson’s Disease and Myasthenia Gravis—A Report of Three New Cases and Review of the Literature

Abstract

Neurodegenerative diseases such as Parkinson’s disease (PD)have increasing incidence, due to lifespan expansion. The association between PD and Myasthenia Gravis (MG) is uncommon, and so far, since 1987, 26 cases have been reported. We report here a series of three new cases, two men and one woman with this peculiar combination of conditions, identified in the Neurology Department of Colentina Clinical Hospital. In this article, the pathogenesis of MG in patients with PD is discussed, along with a literature review regarding the co-occurrence of these two neurological diseases.

Anti-Muscle Specific Kinase (Anti-MuSK) Positive Myasthenia Gravis Overlapping With Parkinson’s Disease: A Challenging Diagnosis

“…In this report, we present another case of positive anti-MuSK MG overlapping with PD. Basically, the diagnosis of PD and MG simultaneously is often challenging due to the rareness of the concomitant of both diseases [ 7 ]. Moreover, they both share many symptoms that make the diagnosis vague and blurry, such as dysphagia, dysarthria, and eye movement, but with careful history-taking and physical examination, one can notice and differentiate the overlapping symptoms between PD and MG [ 7 ].…”

“…Basically, the diagnosis of PD and MG simultaneously is often challenging due to the rareness of the concomitant of both diseases [ 7 ]. Moreover, they both share many symptoms that make the diagnosis vague and blurry, such as dysphagia, dysarthria, and eye movement, but with careful history-taking and physical examination, one can notice and differentiate the overlapping symptoms between PD and MG [ 7 ]. Muscle weakness is usually accompanied by MG and is worse by the end of the day or after repetitive movement, but patients with PD tend to have limb rigidity rather than muscle weakness [ 5 , 14 - 15 ].…”

“…In the previous reports of PD overlapping with MG, the features of parkinsonism in almost all patients were treated by levodopa as our patient. All reported cases were treated by steroid alone or combined with azathioprine for MG [ 7 ]. Our patient had an excellent response to rituximab, which is typical for anti-MuSK MG.…”

“…Whereas Parkinson's disease (PD) has an incidence of approximately eight to 18.6 per 100,000 persons in a year [ 6 ]. The concomitance between PD and MG is rare, and since 1987, 29 cases have been reported [ 7 ]. In this report, we present a case of positive anti-MuSK MG overlapping with PD.…”

A Case Report of Parkinson’s Disease in a 70 year Man With Myasthenia Gravis

“…Since 1987, when the first case report of a patient with PD who later developed MG was reported, 25 more cases have been published, of which MG preceded a diagnosis of PD in only two cases. Out of all 26 published cases, the majority were male-19 cases-and only seven were female, with a ratio of approximatively 3:1, ranging between 55 and 95 yearsold, with a medium of 72 years [1]. The prevalence of Parkin-son's disease (PD) in the elderly population exceeds 1 percent ac-cording to recent reports , whereas myasthenia gravis (MG) is much rarer .…”