Total drug treatment and comorbidity in myasthenia gravis: a population‐based cohort study

Andersen, J. B.; Owe, Jone Furulund; Engeland, Anders; Gilhus, Nils Erik

doi:10.1111/ene.12439

Cited by 33 publications

(40 citation statements)

References 21 publications

(25 reference statements)

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“…Although these comorbidities increase the complexity of medical treatment, advances in medical science have reduced mortality from myasthenia gravis [20,23]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

et al. 2017

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ObjectiveTo validate the comprehensive features of adverse outcomes after surgery for patients with myasthenia gravis.MethodsUsing reimbursement claims from Taiwan’s National Health Insurance Research Database, we analyzed 2290 patients who received major surgery between 2004 and 2010 and were diagnosed with myasthenia gravis preoperatively. Surgical patients without myasthenia gravis (n = 22,900) were randomly selected by matching procedure with propensity score for comparison. The adjusted odds ratios and 95% confidence intervals of postoperative adverse events associated with preoperative myasthenia gravis were calculated under the multiple logistic regressions.ResultsCompared with surgical patients without myasthenia gravis, surgical patients with myasthenia gravis had higher risks of postoperative pneumonia (OR = 2.09; 95% CI: 1.65–2.65), septicemia (OR = 1.31; 95% CI: 1.05–1.64), postoperative bleeding (OR = 1.71; 95% CI: 1.07–2.72), and overall complications (OR = 1.70; 95% CI: 1.44–2.00). The ORs of postoperative adverse events for patients with myasthenia gravis who had symptomatic therapy, chronic immunotherapy, and short-term immunotherapy were 1.76 (95% CI 1.50–2.08), 1.70 (95% CI 1.36–2.11), and 4.36 (95% CI 2.11–9.04), respectively.ConclusionsPatients with myasthenia gravis had increased risks of postoperative adverse events, particularly those experiencing emergency care, hospitalization, and thymectomy for care of myasthenia gravis. Our findings suggest the urgency of revising protocols for perioperative care for these populations.

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“…Although these comorbidities increase the complexity of medical treatment, advances in medical science have reduced mortality from myasthenia gravis [20,23]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

et al. 2017

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“…OPs are potent, lipophilic neurotoxicants that irreversibly inhibit acetylcholinesterase (AChE) and cause acetylcholine (ACh) accumulation in the synaptic cleft [2]. The accumulation of ACh resulting from treatment with pysostig-mine [3], pyridostigmine (PY) [4], or other AChE inhibitors also has a therapeutic rationale. The purpose of this work was to analyze the cellular differentiation of neural progenitors when AChE is constantly inhibited by either an irreversible or reversible AChE inhibitor.…”

Section: Introductionmentioning

confidence: 99%

Paraoxon and Pyridostigmine Interfere with Neural Stem Cell Differentiation

et al. 2015

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Acetylcholinesterase (AChE) inhibition has been described as the main mechanism of organophosphate (OP)-evoked toxicity. OPs represent a human health threat, because chronic exposure to low doses can damage the developing brain, and acute exposure can produce long-lasting damage to adult brains, despite post-exposure medical countermeasures. Although the main mechanism of OP toxicity is AChE inhibition, several lines of evidence suggest that OPs also act by other mechanisms. We hypothesized that rat neural progenitor cells extracted on embryonic day 14.5 would be affected by constant inhibition of AChE from chronic exposure to OP or pyri-dostigmine (a reversible AChE blocker) during differentiation. In this work, the OP paraoxon decreased cell viability in concentrations >50 μM, as measured with the MTT assay; however, this effect was not dose-dependent. Reduced viability could not be attributed to blockade of AChE activity, since treatment with 200 μM pyri-dostigmine did not affect cell viability, even after 6 days. Although changes in protein expression patterns were noted in both treatments, the distribution of differentiated phenotypes, such as the percentages of neurons and glial cells, was not altered, as determined by flow cytometry. Since paraoxon and pyridostigmine each decreased neurite outgrowth (but did not prevent differentiation), we infer that developmental patterns may have been affected.

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“…7,8 However, in the presence of these three signs associated to bulbar complaints such as dysphonia and dysphagia, it is imperative to search these rare presentation of MG. A poor response to pyridostigmine, even in high doses, is a crucial finding and should raise suspicion of this rare myasthenic syndrome that shows a more reliable improvement with immunosupressor agents. 9 …”

Section: Discussionmentioning

confidence: 99%

Anti-musk positive myasthenia gravis and three semiological cardinal signs

et al. 2017

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Myasthenia gravis (MG) is a relatively uncommon disorder with an annual incidence of approximately 7 to 9 new cases per million. The prevalence is about 70 to 165 per million. The prevalence of the disease has been increasing over the past five decades. This is thought to be due to better recognition of the condition, aging of the population, and the longer life span of affected patients. MG causes weakness, predominantly in bulbar, facial, and extra-ocular muscles, often fluctuating over minutes to weeks, in the absence of wasting, sensory loss, or reflex changes. The picture of fluctuating, asymmetric external ophthalmoplegia with ptosis and weak eye closure is virtually diagnostic of myasthenia. We report an atypical MG case with three semiological cardinal signs.

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Total drug treatment and comorbidity in myasthenia gravis: a population‐based cohort study

Cited by 33 publications

References 21 publications

Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

Outcomes after major surgery in patients with myasthenia gravis: A nationwide matched cohort study

Paraoxon and Pyridostigmine Interfere with Neural Stem Cell Differentiation

Anti-musk positive myasthenia gravis and three semiological cardinal signs

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