Perspectives of Neuro-COVID: Myasthenia

Finsterer, Josef; Scorza, Fúlvio A.

doi:10.3389/fneur.2021.635747

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…There is currently controversial data regarding the relationship between COVID-19 and MG outcome, due to the coexistence of reports of both stable[ 53 ] and worsening[ 46 , 54 – 57 ] MG cases, during the course of COVID-19. In any case, available data suggest that there is no association between COVID-19 severity and risk of myasthenic exacerbation, as even mild COVID-19 cases may trigger MG worsening [ 58 ]. In parallel, an important French study found that higher baseline MG severity was associated with COVID-19 severity, whereas neither of the latter two were associated with MG outcome after COVID-19 [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Sansone

Bonifati

2022

J Neurol

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Introduction Myasthenia gravis (MG) is an autoimmune disease, for which the risk of exacerbation after vaccines is debated. The aim of this study is to review the available literature concerning safety and efficacy of vaccines in MG. In addition, we also conducted a retrospective research of MG exacerbations and new onset MG after anti-SARS-CoV-2 vaccination in a large cohort of patients. Methods A study of the available literature regarding vaccines and MG was carried out through research in the online database “Pubmed”. We also retrospectively collected data from 80 MG patients, who were followed at the Treviso Hospital and completed an anti-SARS-CoV-2 vaccination cycle. For each patient, we recorded MG exacerbations between first and second doses and within a window period of 1 day – 6 weeks after the second dose. Results We found 26 relevant articles about influenza, SARS-CoV-2 and other vaccines. No clear associations between most vaccines and MG exacerbations were found. Moreover, cases of new onset post-vaccine MG are mostly anecdotal, except for Japanese encephalitis virus vaccine. Concerning our cohort, 4/80 (5%) MG patients experienced an exacerbation within the post-vaccine window period. In addition, we report a case of new onset post-vaccine MG. Discussion Inactivated and subunit vaccines are safe and effective in MG. Although some of them, such as anti-SARS-CoV-2 vaccine, might uncommonly cause MG exacerbations, data from our review suggest that benefits still outweigh by far the potential risks, thus they should be recommended to these patients. Nevertheless, large prospective studies are needed for further investigations.

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Section: Discussionmentioning

confidence: 99%

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Sansone

Bonifati

2022

J Neurol

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“…There were 6 descriptive studies about new-onset of MG after COVID-19 infection. The similar structure from acetylcholine receptor and SARS-CoV-2 receptor, activation latent autoimmune disease, and hyperinflammation (such as multisystem inflammatory syndrome in children) may be the possible explanation of it [ 9 , 19 , 40 , 41 , 45 , 47 , 50 ]. This condition requires the use of mechanical ventilation, sedating, and paralytic drugs.…”

Section: Discussionmentioning

confidence: 99%

The relationship between myasthenia gravis and COVID-19: a systematic review

Tugasworo

Kurnianto

Retnaningsih

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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Introduction Viral infection such as coronavirus disease 2019 (COVID-19) can exacerbate and aggravate neurological disorders due to autoimmune etiology like myasthenia gravis (MG). Experimental therapies used in COVID-19 are also factors that can cause the worsening of MG symptoms. This review aimed to assess and conclude the research-based study systematically to analyze the relationship of MG and COVID-19. Method This study was conducted in accordance to Cochrane handbook for systematic reviews and the guideline of preferred reporting items for systematic review and meta-analysis (PRISMA) and synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. Inclusion criteria in this review were primary studies of every design, articles published in English around January 2000–October 2021, and the study used human as subject. A systematic literature finding was applied in 15 electronic scientific resources. The authors evaluated the study quality and risk of bias of each retrieved article. Results The authors found the study through electronic scientific resources that met inclusion and exclusion criteria. The authors evaluated 362 articles identified in literature searching, 22 articles met the criteria for this review and then underwent the evaluation of study quality and risk of bias. Conclusion COVID-19 infection can increase the risk of new-onset MG, myasthenic crisis, respiratory failure, and mortality rate due to cytokine storm in MG patients. The management of COVID-19 patients with MG is tailored to each person and based on national guidelines and local expert recommendations.

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“…Another issue is the limited access to systematic MG severity assessment by the attending neurologist and modification of the treatment regimen. However, the available data has shown highly variable MG reactions to COVID-19 that were independent of the viral infection's severity [9]. Some reports have described MG exacerbations during COVID-19, while others have shown a stable MG course throughout this infection [10,11].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

Rzepiński¹,

Zawadka‐Kunikowska

2022

Neurol Neurochir Pol.

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Aim of the study: Coronavirus disease 2019 (COVID-19) incidence, mortality, recovery and hospitalisation rates vary in different countries. This study aimed to present the clinical characteristics of a sample of unvaccinated Polish myasthenia gravis (MG) patients during the first year of the COVID-19 pandemic, taking into account the number of MG exacerbations, a detailed description of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection course, and the need to modify immunosuppressive therapies. Clinical rationale for the study:To assess the impact of the first COVID-19 pandemic year on MG course in a sample of unvaccinated patients. Materials and methods: A retrospective observational study involving 30 unvaccinated Polish MG patients consulted in a neurological outpatient clinic on 11-31 March, 2020 (baseline) and 11-31 March, 2021 (endpoint).Results: During the period of evaluation, exacerbation of MG requiring hospitalisation was reported in 11 patients. Among them, four were treated with intravenous immunoglobulin and another six required plasma exchange. In the study group, COVID-19 was identified in 10 patients. Of them, seven experienced a mild course of SARSCoV-2 infection with spontaneous recovery. In the remaining three patients, both MG exacerbation and SARS-CoV-2 infection were reported. These patients experienced MG exacerbation in the preceding month or concurrently with COVID-19 and were aged over 50 years. Due to the SARS-CoV-2 infection, they required antibiotic and oxygen therapy, and hospitalisation was necessary in the case of two obese patients. None of the patients died due to COVID-19, and nor did any require discontinuation of immunosuppressive therapies during the study period. In total, 12 patients in the study group experienced neither MG exacerbation nor SARS-CoV-2 infection. Conclusions:In the presented sample of Polish MG patients, favourable outcomes of COVID-19 were observed. Further studies are needed to evaluate the reliable course of COVID-19 taking into account international differences, the types of treatment applied, and the ratio of vaccinated to unvaccinated MG patients.

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Perspectives of Neuro-COVID: Myasthenia

Cited by 10 publications

References 31 publications

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

The relationship between myasthenia gravis and COVID-19: a systematic review

COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

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