Myasthenia Gravis
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  • ||||||||||  Journal:  Biological therapies for myasthenia gravis. (Pubmed Central) -  Mar 14, 2023   
    Several biological therapies have been developed for MG, and these biologics are promising agents for treating refractory MG. Establishing biomarkers and accumulating evidence of therapeutic response is required to provide the most appropriate biological treatment for each patient.
  • ||||||||||  Soliris (eculizumab) / AstraZeneca, Ultomiris IV (ravulizumab IV) / AstraZeneca
    Journal:  Ravulizumab for the treatment of myasthenia gravis. (Pubmed Central) -  Mar 14, 2023   
    P3
    Establishing biomarkers and accumulating evidence of therapeutic response is required to provide the most appropriate biological treatment for each patient. Like eculizumab, ravulizumab is an anti-C5 monoclonal antibody, but with an enhanced pharmacokinetic profile, that allows dosing every 8
  • ||||||||||  Retrospective data, Journal:  Chronic mimics of myasthenia gravis: a retrospective case series. (Pubmed Central) -  Mar 14, 2023   
    We found myasthenic mimics should be suspected in disease that is static and treatment refractory, and functional mimics in disease with frequent flares. Thorough neurophysiologic assessment is important, particularly when making a diagnosis of seronegative myasthenia gravis.
  • ||||||||||  Journal:  New-Onset Myasthenia Gravis Following COVID-19 Vaccination. (Pubmed Central) -  Mar 14, 2023   
    Considering the physiological muscle weakness that occurs in the elderly, it may be necessary to monitor ICI-related MG more closely in older people. No abstract available
  • ||||||||||  Neurotoxoplasmosis: a 5-year story in the Dominican Republic (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_4290;    
    HIV patients require continuous monitoring to avoid preventable conditions, such as neurotoxoplasmosis. Given the sociocultural context, what can we do to increase follow-up and HAART adherence?
  • ||||||||||  Acute Neurological Consultation in Patients with Cervical Orthopedic Intervention (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_4236;    
    This is a reported potential complication of ACDF and can occur due to interruption of the cervical sympathetic trunk, at risk of injury when the longus Capitus muscle is cut or during dissection of the pre vertebral fascia. Awareness of this rare neurologic manifestation of cervical disc fusion can assist in avoiding unnecessary testing for other neurologic disease.
  • ||||||||||  AChR+Ve Myasthenia Gravis (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_3766;    
  • ||||||||||  levetiracetam / Generic mfg., acyclovir / Generic mfg.
    AMPA receptor antibody encephalitis in a patient with Myasthenia Gravis post thymectomy (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_3405;    
    She then had an episode of right gaze deviation with worsening of consciousness, so she required mechanical ventilatory support for airway protection and was treated with levetiracetam for seizures...Serum Herpes Simplex Virus (HSV) 1 antibody was positive so patient remained on Acyclovir but later CSF nucleic acid amino transferase HSV PCR was negative...Conclusions This patient had a poor clinical outcome. Therefore, it is important to further understand the pathology and have low threshold for treating AMPAR antibody encephalitis in a patient with history of MG and thymoma status post thymectomy.
  • ||||||||||  Seeing Double: a Case of a Massive Type B2 Thymoma Presenting with Pseudo-Internuclear Ophthalmoplegia (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_3307;    
    The incidental finding of a large thymoma (measuring ~30cm) discovered on thoracic spine imaging for work-up of demyelinating disease prompts alternative diagnostic consideration when presented with MRI-negative INO. It also evokes the question, should there be more emphasis on expediting CT chest imaging to evaluate for thymoma in patients with antibody positive MG.
  • ||||||||||  fluoxetine / Generic mfg.
    A Novel Homozygous Variant in the CHRNE Gene in 2 Siblings with Congenital Myasthenic Syndrome (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_3266;    
    Since the mutation was in the CHRNE gene, which codes for the epsilon subunit of the acetylcholine receptor, the brother was initially treated with fluoxetine, which had no response...Design/Methods Not applicable Results Not applicable Conclusions Two siblings born to consanguineous parents both shared a homozygous mutation in the CHRNE gene, presenting similarly with symptoms consistent with congenital myasthenic syndrome, responded favorably to pyridostigmine. Given then, we rationalize that the homozygous c.322C>T (p.Pro108Ser) variant in the CHRNE gene causes an acetylcholine receptor deficiency type of congenital myasthenic syndrome.
  • ||||||||||  Free Neurology Community Health Clinic: Insights on Patient Population and Resident Experience (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_3095;    
    Resident feedback demonstrated overwhelmingly positive impact on fulfillment and clinical education, as well as future career involvement in underserved populations. Future directions for FNCHC include expanding diagnostics, therapeutics, and formal integration into residency education.
  • ||||||||||  Ultomiris IV (ravulizumab IV) / AstraZeneca, Vyvgart (efgartigimod alfa-fcab) / argenx, Broteio
    Real World Experience of New MG Therapies: Single Center Cohort Study (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2729;    
    The study is ongoing with hopes to have data from 25-50 patients in the coming months. Conclusions The study is presently ongoing.
  • ||||||||||  Comorbid Contributors to Fatigue in Myasthenia Gravis (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2727;    
    For psychiatric comorbidities, 46% scored >50 on the anxiety and 50% scored >50 on the depression portion. Conclusions The results of this study suggest that fatigue in patients with myasthenia gravis is multifactorial and routine screening for other causes is warranted.
  • ||||||||||  A Quantifiable Telemedicine Approach to the Myasthenia Gravis Neurological Exam (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2725;    
    As a matter of fact, the time dynamic component of muscle weakness seems an important factor in the evaluation of the symptoms. We envision that our telehealth approach can be applied to other neuromuscular diseases and will be providing quantitative metrics that goes beyond in an in-person visit.
  • ||||||||||  The Impact of Generalized Myasthenia Gravis Severity on Work and Daily Activities: A Real World Study (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2723;    
    Conclusions Generalized Myasthenia Gravis impacts the ability to work and perform daily activities with more severe disease associated with greater impairment. Treatments that control symptoms resulting in less severe disease could have a positive impact on work and daily activities of patients living with gMG.
  • ||||||||||  Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
    Sex Differences in Therapy for Myasthenia Gravis (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2719;    
    Conclusions Females with MG are less likely to be treated with low dose prednisone and more likely to be treated with rituximab than males. Sex differences in treatment approaches may contribute to disparity in disease outcome and QoL measures.
  • ||||||||||  COVID19 Infection in Myasthenia Gravis: Predictors of Severity (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2718;    
    There was no significant association between the severities of COVID-19 and MG (p=0.716) even after controlling for confounding factors. Moreover, we asserted that vaccination (p<0.001) and younger age (P=0.006) are associated with better COVID-19 outcome in MG patients.
  • ||||||||||  mycophenolate mofetil / Generic mfg.
    DaT Scan Positive Parkinson (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2213;    
    After thorough workup with serologic and electrophysiologic studies, patient was diagnosed with seropositive bulbar predominant MuSK Myasthenia Gravis for which steroid sparing immunosuppressive treatment was initiated with mycophenolate mofetil...Conclusions This case demonstrates the clinical challenges that present in this overlap of neuromuscular and neurodegenerative disease in a single individual. We highlight the importance of a thorough history and physical examination, supported with objective evidence by a positive DaT scan, to elucidate the appropriate etiology of symptoms.
  • ||||||||||  Categorizing Movement Disorders Associated with Toxic Exposures at Camp Lejeune Military Base (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2209;    
    Further, there was a high prevalence of co-incident neurologic conditions in both the PD and non-PD populations. While we cannot imply causality with exposure to toxins at Camp Lejeune, these data suggest exposure to these toxins are associated with a broader spectrum of neurologic symptoms than previously thought and warrants further study.
  • ||||||||||  methylprednisolone sodium succinate / Generic mfg.
    From WEMINO To WEBINO With Unilateral LMN Facial Palsy (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2120;    
    She received intravenous methylprednisolone and her symptoms nearly resolved by day 14...The anatomical correlate was confirmed on repeated imaging. Her clinical course beautifully illustrates the importance of lesion localization for etiological diagnosis.
  • ||||||||||  Keytruda (pembrolizumab) / Merck (MSD)
    Two Cases of Anti-PD1 Antibody Associated Neurological Immune-Related Adverse Effects (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_2119;    
    His symptoms were therefore suspected to be secondary to autoimmune encephalitis elicited by pembrolizumab administration. His oncologist elected to transition to another treatment regimen, and he has had no relapses to date.
  • ||||||||||  Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
    Pre-existing Lambert-Eaton Myasthenic Syndrome and Scleroderma in a Patient with Neuroendocrine Tumor undergoing Immune Checkpoint Inhibitor Cancer Immunotherapy (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_1946;    
    She was diagnosed with neuroendocrine tumor and treated with weekly IVIg, chemotherapy (carboplatin and etoposide) and radiation with some improvement...Due to cancer progression, she was treated with ICIs (ipilimumab and nivolumab) with concomitant IVIg...Her clinical presentation upon progression with dropped head could be related to LEMS with secondary myopathic change or an ICI-triggered-myopathy. This patient illustrates the complexity of therapeutic decision making in these patients and the necessity of a multidisciplinary approach.
  • ||||||||||  Keytruda (pembrolizumab) / Merck (MSD), Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
    Immune Checkpoint Inhibitors Related New Onset Myasthenia Gravis: Case Series (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_1945;    
    Symptoms improved dramatically with IVIG. His course was complicated by rostral brainstem ischemic stroke and discharged
  • ||||||||||  CD11c+ B cells Are Fundamentally Altered in Muscle-Specific Tyrosine Kinase Antibody Positive Myasthenia Gravis (Both in-person and online) -  Mar 12, 2023 - Abstract #AAN2023AAN_1584;    
    Conclusions The reduced population of CD11c+ B cell population in MuSK-MG patients along with the downregulation of genes associated with IgG1 class switching indicate an altered immune pathway is involved in the development of autoantibody producing cells. The mechanisms underlying the development of IgG1 in AChR-MG and IgG4 in MuSK-MG demonstrate these are two distinct diseases.