Treatment of epilepsy in patients with myasthenia gravis: Is really harder than it looks?

Lorenzoni, Paulo José; Ducci, Renata Dal‐Prá; Tensini, Tallulah Spina; Dalledone, Giuliano Ohde; Kay, Cláudia Suemi Kamoi; Paola, Luciano De; Werneck, Lineü Cesar; Scola, Rosana Hermínia; Silvado, Carlos Eduardo

doi:10.1016/j.jocn.2017.06.067

Cited by 5 publications

(11 citation statements)

References 16 publications

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“…The association between MG and seizure occurrence is still controversial. One cohort study reported that about 3% of people with MG had epilepsy [70]. One population-based study has shown that the risk of epilepsy in MG was 4.9-fold greater than expected [8].…”

Section: Myasthenia Gravis (Mg)mentioning

confidence: 99%

Seizures as a clinical manifestation in somatic autoimmune disorders

Amanat

Thijs

Salehi

et al. 2019

Seizure

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A B S T R A C TThe risk of epileptic seizures seems increased in several systemic autoimmune disorders including systemic lupus erythematosus, type 1 diabetes mellitus, myasthenia gravis, celiac disease, rheumatoid arthritis, Hashimoto's encephalopathy, psoriasis, multiple sclerosis, neuromyelitis optica, and bullous pemphigoid. Immune dysfunction may be partly responsible for this association. Elevated levels of pro-inflammatory cytokines, autoantibodies seen in these autoimmune disorders and antibodies against neuronal antigens may contribute to the etiopathogenesis of seizures and epilepsy associated to immune conditions. Other unknown factors, the effect of different co-morbid conditions of epilepsy as well as shared risk factors such as common etiological factors, environmental triggers, or a common genetic predisposition may also explain the association. We review different autoimmune disorders which may present with co-morbid seizures and discuss possible underlying mechanisms of this co-occurrence focusing on a potential role of immune system dysfunction.

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Section: Myasthenia Gravis (Mg)mentioning

confidence: 99%

Seizures as a clinical manifestation in somatic autoimmune disorders

Amanat

Thijs

Salehi

et al. 2019

Seizure

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“…8,9 Since early on in the HIV epidemic, multiple cases of HIV-ALS have been described. [10][11][12][13][14][15][16] HIV-ALS can cause a clinical presentation compatible with sporadic ALS (sALS). [15] HIV-ALS tends to occur at younger age, with a more severe and progressive phenotype.…”

mentioning

confidence: 99%

“…[10][11][12][13][14][15][16] HIV-ALS can cause a clinical presentation compatible with sporadic ALS (sALS). [15] HIV-ALS tends to occur at younger age, with a more severe and progressive phenotype. 7,[10][11][12][13][14][15] The occurrence of HIV-ALS is not related to the duration or stage of the HIV infection.…”

mentioning

confidence: 99%

“…[15] HIV-ALS tends to occur at younger age, with a more severe and progressive phenotype. 7,[10][11][12][13][14][15] The occurrence of HIV-ALS is not related to the duration or stage of the HIV infection. 14 SSA accounts for over 70% of the global HIV epidemic.…”

mentioning

confidence: 99%

“…In patients with HIV-ALS a response to ART has been described in previous case reports. 7,[10][11][12][13][14][15] The diagnostic consideration of HIV-ALS is important since treatment with ART can affect the course of the disease.…”

mentioning

confidence: 99%

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Ten-year plateau phase in human immunodeficiency virus induced motor neuron disease upon antiretroviral therapy: a first case from Eastern Africa.

Bruin

Assay

Osman

et al. 2020

rrnmf

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We report an individual with rapidly progressive motor neuron disease (MND), phenotypically compatible with amyotrophic lateral sclerosis (ALS). The patient described in this case report proved positive for human immunodeficiency virus (HIV) and was initiated on antiretroviral therapy (ART). Following ART he clinically stabilised over 10 years and deteriorated again due to noncompliance or ART resistance. HIV infection can give rise to an MND mimic, HIV-ALS. The improvement in response to ART supports the notion that HIV-ALS is a treatable entity also in Africa. This is the first case report of a patient with HIV-ALS and long term follow up in Sub-Saharan Africa. The report raises the suggestion that an additional (retro)virus can play a role in the aetiology of ALS.

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Epilepsy and autoimmune diseases: Comorbidity in a national patient cohort

Børsheim

Engeland

Gilhus

2020

Seizure

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To examine if autoimmune disorders occur with an increased frequency in patients with epilepsy. An autoimmune etiology of epilepsies has been suggested. By using data from The Norwegian Prescription Database (NorPD) we have surveyed a national cohort of patients with active epilepsy treated with antiepileptic drugs. Methods: NorPD contains all prescriptions of drugs dispensed at pharmacies in Norway since 2004. We received data of all drugs prescribed January 2004 -June 2014 for patients receiving an antiepileptic drug.79 751 patients receiving at least two prescriptions of antiepileptic drugs with the reimbursement code for epilepsy were included. To examine autoimmune comorbidity, medications specific for autoimmune diseases were retrieved. Standardized Incidence Ratios (SIR) with 95 % confidence interval (CI) were used to determine whether the occurrence of the prescribed autoimmune drugs in the epilepsy group deviated from the general population. Subgroups stratified for sex and age were examined. Results: The epilepsy patients were more often treated with insulin and insulin analogs, SIR 1.8 (95 % CI 1.7-1.9); thyroid substitution, SIR 1.7 (95 % CI 1.7-1.8); pyridostigmine, SIR 1.5 (95 % CI 1.1-2.1); multiple sclerosis (MS) medications, SIR 4.9 (95 % CI 4.6-5.3); and immunosuppressive drugs SIR 1.2 (95 % CI 1.1-1.2). All epilepsy subgroups were more often than expected treated with thyroid substitution. Conclusions: Based on a large, unselected patient cohort we find that epilepsy patients more often are prescribed medications used to treat type 1 diabetes mellitus, hypothyroidism, myasthenia gravis and MS. This was true for both men and women, and in most age-groups.

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Treatment of epilepsy in patients with myasthenia gravis: Is really harder than it looks?

Cited by 5 publications

References 16 publications

Seizures as a clinical manifestation in somatic autoimmune disorders

Seizures as a clinical manifestation in somatic autoimmune disorders

Ten-year plateau phase in human immunodeficiency virus induced motor neuron disease upon antiretroviral therapy: a first case from Eastern Africa.

Epilepsy and autoimmune diseases: Comorbidity in a national patient cohort

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