- |||||||||| Vimpat (lacosamide) / UCB, Daiichi Sankyo
[VIRTUAL] Thymoma Associated with Autoimmune Multifocal Cortical Encephalitis and Subsequent Myasthenia Gravis () - Oct 21, 2021 - Abstract #ANA2021ANA_408;
Our case report is only the third reported case of thymoma-associated multifocal cortical encephalitis, which shows that autoimmune encephalitis can extend to cortical regions outside the limbic system. We should consider autoimmune encephalitis in the differential diagno sis of patients with myasthenia gravis or thymoma who develop new cognitive symptoms.
- |||||||||| Soliris (eculizumab) / AstraZeneca
Journal: Consistent improvement with eculizumab across muscle groups in myasthenia gravis. (Pubmed Central) - Oct 20, 2021
P3
Efgartigimod demonstrated significant efficacy in treating patients with gMG, with no significant safety issues. Eculizumab treatment elicits rapid and sustained improvements in muscle strength across ocular, bulbar, respiratory, and limb/gross motor muscle groups and in associated daily activities in patients with refractory anti-acetylcholine receptor antibody-positive generalized myasthenia gravis.
- |||||||||| Vesicare (solifenacin) / Astellas
Clinical, Reimbursement, Journal, Medicare: Antimuscarinic use among older adults with dementia and overactive bladder: a medicare beneficiaries study. (Pubmed Central) - Oct 20, 2021
Majority of the incident users were prescribed non-selective antimuscarinics with several demographic and clinical factors contributing to their prescribing. Given the high prevalence of OAB among dementia patients, there is a need to optimize their antimuscarinics use, considering their vulnerability for anticholinergic adverse effects.
- |||||||||| Clinical, Retrospective data, Journal: Risk factors of prolonged ventilation after thymectomy in thymoma myasthenia gravis patients. (Pubmed Central) - Oct 20, 2021
The pooled results of RCTs demonsrated with moderate to high evidence that 3,4-DAP has a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude. The nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.
- |||||||||| Clinical, Retrospective data, Journal: Hemogram parameters can predict in-hospital mortality of patients with Myasthenic crisis. (Pubmed Central) - Oct 20, 2021
This study demonstrated that both old age at MC onset and moderate-to-severe anemia are important predictors of in-hospital mortality in patients with MC, and extreme leukocytosis is another crucial predictor of mortality during mechanical ventilation. The suggested mechanism is that anemia-induced hypoxia may enhance the release of proinflammatory cytokines, exacerbate systemic inflammation, and lead to multiple organ dysfunction syndrome and, finally, mortality.
- |||||||||| Journal: Exceptional thyrolipoma and thymolipoma association: is there a syndrome? (Pubmed Central) - Oct 16, 2021
For the first time, we report the occurrence of both neoplasms associated with myasthenia gravis in a 64-year-old woman. The value of this case report lies not only in the fact that it allows us to speculate on the presence of a syndrome but also because a complete radiological work-up (computed tomography scanner, magnetic resonance imaging, Positron emission tomography (PET) with fluorodeoxyglucose (FDG)) is reported.
- |||||||||| Review, Journal: To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis. (Pubmed Central) - Oct 16, 2021
Since only a handful of studies have reported vaccination in individuals with MG, we further review the current clinical studies and guidelines in rheumatic diseases. Overall, our reviews offer a reference to guide future vaccine clinical decision-making and improve the management of MG patients.
- |||||||||| Review, Journal: MuSK antibodies, lessons learned from poly- and monoclonality. (Pubmed Central) - Oct 14, 2021
The source of MuSK antibodies and consequently their (mixed) polyclonal or monoclonal nature were important confounding factors in these experiments. Here we review the variety of MuSK antibodies described thus far, the insights they have given us and their potential for the future.
- |||||||||| Biomarker, Journal: Laboratory Investigation of Hybrid IgG4 k/λ in MuSK Positive Myasthenia Gravis. (Pubmed Central) - Oct 14, 2021
In both subtypes of MG, we found that the hybrid/total ratio reflects distribution reported in normal individuals; instead, when we correlated the hybrid/total ratio with specific immune-reactivity we found a positive correlation only with anti-MuSK titer, with a progressive increase of hybrid/total mean values with increasing disease severity, indirectly confirming that most part of hybrid IgG4 molecules are engaged in the anti-MuSK pathogenetic immune-reactivity. Further analysis is necessary to strengthen the significance of this less unknown biomarker, but we retain it is full of a diagnostic-prognostic powerful potential for the management of MuSK-MG.
- |||||||||| Clinical, Journal: Myasthenia gravis: do not forget the patient perspective. (Pubmed Central) - Oct 13, 2021
Further analysis is necessary to strengthen the significance of this less unknown biomarker, but we retain it is full of a diagnostic-prognostic powerful potential for the management of MuSK-MG. No abstract available
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS
[VIRTUAL] IMMUNE CHECKPOINT INHIBITOR-INDUCED MYASTHENIC CRISIS () - Oct 13, 2021 - Abstract #CHEST2021CHEST_2206;
Clinicians should include alveolar hypoventilation caused by myasthenia gravis in the differential of isolated mixed respiratory failure even in the absence of other symptoms, especially in the setting of a normal A-a gradient. Increasing use of checkpoint inhibitor immunotherapy in the treatment of a variety of malignancies necessitates an understanding of their common adverse events, including, as highlighted in this case, recognition of neurologic causes of respiratory failure.
- |||||||||| [VIRTUAL] BRONCHOPLEURAL FISTULA? ENDOBRONCHIAL VALVES TO THE RESCUE () - Oct 13, 2021 - Abstract #CHEST2021CHEST_2076;
Increasing use of checkpoint inhibitor immunotherapy in the treatment of a variety of malignancies necessitates an understanding of their common adverse events, including, as highlighted in this case, recognition of neurologic causes of respiratory failure. EBV placement is a minimally invasive procedure which can be performed to help with PAL associated with small BPF (<5mm) when surgery is not an option.
- |||||||||| [VIRTUAL] THYMOMA MIMICKING A LUNG MASS () - Oct 13, 2021 - Abstract #CHEST2021CHEST_1853;
EBV placement is a minimally invasive procedure which can be performed to help with PAL associated with small BPF (<5mm) when surgery is not an option. Thymomas can mimic lung malignancy on imaging studies and need histologic exam to confirm the diagnosis.
- |||||||||| [VIRTUAL] AN INCIDENTALOMA NOT LOCATED IN THE ADRENAL GLAND () - Oct 13, 2021 - Abstract #CHEST2021CHEST_1658;
Multidisciplinary medical and surgical teams are needed to manage thymic cancer. It is often a resectable disease, frequently causes paraneoplastic phenomena, is amenable to radiation and systemic therapies, and has a widely variable prognosis.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
[VIRTUAL] EYES WIDE SHUT: AN UNUSUAL CAUSE OF PTOSIS () - Oct 13, 2021 - Abstract #CHEST2021CHEST_920;
These symptoms tend to develop within the first few cycles of treatment. Physicians should consider this as a differential when encountering similar patients.
- |||||||||| [VIRTUAL] WOUND BOTULISM PRESENTING AS CARDIAC ARREST () - Oct 13, 2021 - Abstract #CHEST2021CHEST_503;
The incidence of wound botulism has been on the rise as a result of contaminated subcutaneous heroin use and should be considered as a differential diagnosis. Early recognition of this deadly disease and rapid antitoxin administration leads to better patient outcomes.
- |||||||||| Retrospective data, Journal: Robotic surgery vs. open surgery for thymectomy, a retrospective case-match study. (Pubmed Central) - Oct 13, 2021
The robotic-assisted technique showed the same operative time and complications rate compared with open surgery, thereby confirming its safety and feasibility in myasthenic patients as well as in Masaoka I-II thymomas. The lower postoperative pain and the shorter hospital stay associated with prompt mobilisation and faster chest drainage removal showed the great advantage of the minimally invasive robotic approach in these patients.
- |||||||||| Clinical, Journal: Cholinergic hyperactivity in patients with myasthenia gravis with MuSK antibodies: A neurophysiological study. (Pubmed Central) - Oct 13, 2021
Our findings show that a strategy focused on obtaining orphan drug designation, expanding therapeutic indications and the geographic range of marketing approvals, extending monopoly periods, and prioritizing public procurement niches has enhanced revenues and helped the company achieve leadership in a highly specific and profitable market. R-CMAP detection can represent a useful diagnostic clue for MuSK-MG and predicts poor tolerance to AChE-Is.
- |||||||||| pyridostigmine Bromide / Generic mfg., azathioprine / Generic mfg.
Clinical, Journal: Primary biliary cirrhosis associated with myasthenia gravis after postpartum: a case report. (Pubmed Central) - Oct 12, 2021
Given the fluctuation of the immune status during the postpartum period, combined autoimmune diseases need to be taken into account when patients develop clinical symptoms of an autoimmune disease. Therefore, detailed physical and laboratory examination can help to prevent the missed diagnosis of these diseases.
- |||||||||| Clinical, Review, Journal: SARS-CoV-2 (COVID-19) in Patients with some Degree of Immunosuppression (Pubmed Central) - Oct 12, 2021
In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis [MS], neuromyelitis optica [NMODS], myasthenia gravis [MG]), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes. Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer.
- |||||||||| Zilbrysq (zilucoplan) / UCB
Trial completion date, Trial primary completion date: RAISE: Safety, Tolerability, and Efficacy of Zilucoplan in Subjects With Generalized Myasthenia Gravis (clinicaltrials.gov) - Oct 12, 2021
P3, N=174, Active, not recruiting,
Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer. Trial completion date: Nov 2021 --> Feb 2022 | Trial primary completion date: Sep 2021 --> Dec 2021
- |||||||||| Clinical, Journal: Maximizing placebo response in neurological clinical practice. (Pubmed Central) - Oct 9, 2021
Future studies regarding more specific neurobiological mechanisms will allow a finer tuning of placebo response in clinical practice. The use of placebo in clinical practice raises ethical issues, and a recent expert consensus regarding placebo use in the clinic is a first step to future guidelines necessary to this field.
- |||||||||| Clinical, Journal: Coexistence of Systemic Lupus Erythematosus and Myasthenia Gravis: An Unusual Case of Polyautoimmunity. (Pubmed Central) - Oct 8, 2021
The coexistence of myasthenia gravis (MG) and systemic lupus erythematosus (SLE) is a clinical challenge due to the possible differential diagnoses of muscle involvement in patients with SLE. We present the case of a patient who came to the emergency room of Hospital Universitario San Ignacio in Bogotá, Colombia, with a previous diagnosis of SLE, who developed acute weakness in the context of a systemic infection, with a clinical and electrophysiological diagnosis of MG.
- |||||||||| Clinical, Journal: Analysis of the application of glucocorticoids in eight pediatric neurological disorders in China (Pubmed Central) - Oct 7, 2021
The multivariate Logistic regression analysis indicated that the use of glucocorticoids was more standardized in bacterial meningitis (OR=1.83, 95%CI 1.39-2.43, P<0.01), Guillain-Barre syndrome (OR=1.97, 95%CI 1.50-2.59, P<0.01), Duchenne muscular dystrophy (OR=1.85, 95%CI 1.38-2.48, P<0.01), juvenile dermatomyositis (OR=2.08, 95%CI 1.03-4.19, P=0.040) and N-methyl-D-aspartate receptor encephalitis (OR=0.302, 95%CI 0.20-0.46, P<0.01) and by pediatricians with pediatric neurology specialty in the hospital. The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids is less than half in children with neurological diseases, and the use of glucocorticoids is more standardized in a variety of diseases by pediatricians with pediatric neurology specialty in the hospital, which indicates that the study of guidelines or consensus and the special training of pediatric neurologists should be further strengthened.
- |||||||||| Clinical, Journal: Comment on case series of COVID-19 in patients with myasthenia gravis: a single institution experience by Županić et al. (Pubmed Central) - Oct 6, 2021
The coincidence rate with recommendation of the current guideline or consensus on glucocorticoids is less than half in children with neurological diseases, and the use of glucocorticoids is more standardized in a variety of diseases by pediatricians with pediatric neurology specialty in the hospital, which indicates that the study of guidelines or consensus and the special training of pediatric neurologists should be further strengthened. No abstract available
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