Epilepsy and Myasthenia Gravis: A Case Series
Abstract
:1. Introduction
2. Material and Methods
2.1. Patients
2.2. Definitions and Inclusion–Exclusion Criteria
2.2.1. MG Definition [11]
2.2.2. Epilepsy Definition [12]
2.2.3. Autoimmune-Associated Epilepsy [1,14]
2.3. Diagnostic Procedures
2.3.1. Neuroimaging Studies
2.3.2. Immunological Analysis
2.3.3. Electrophysiological Studies
3. Results
3.1. Case 1
3.2. Case 2
3.3. Case 3
3.4. Case 4
3.5. Case 5
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Scheffer, I.E.; Berkovic, S.; Capovilla, G.; Connolly, M.B.; French, J.; Guilhoto, L.; Hirsch, E.; Jain, S.; Mathern, G.W.; Moshé, S.L.; et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017, 58, 512–521. [Google Scholar] [CrossRef] [PubMed]
- Ong, M.-S.; Kohane, I.S.; Cai, T.; Gorman, M.P.; Mandl, K.D. Population-Level Evidence for an Autoimmune Etiology of Epilepsy. JAMA Neurol. 2014, 71, 569–574. [Google Scholar] [CrossRef]
- Wie Børsheim, A.; Engeland, A.; Gilhus, N.E. Epilepsy and autoimmune diseases: Comorbidity in a national patient cohort. Seizure 2020, 75, 89–95. [Google Scholar] [CrossRef] [PubMed]
- Gilhus, N.E.; Tzartos, S.; Evoli, A.; Palace, J.; Burns, T.M.; Verschuuren, J.J.G.M. Myasthenia gravis. Nat. Rev. Dis. Prim. 2019, 5, 30. [Google Scholar] [CrossRef] [PubMed]
- Zhu, Y.; Wang, B.; Hao, Y.; Zhu, R. Clinical features of myasthenia gravis with neurological and systemic autoimmune diseases. Front. Immunol. 2023, 14, 1223322. [Google Scholar] [CrossRef] [PubMed]
- Di Stefano, V.; Iacono, S.; Militello, M.; Leone, O.; Rispoli, M.G.; Ferri, L.; Ajdinaj, P.; Lanza, P.; Lupica, A.; Crescimanno, G.; et al. Comorbidity in myasthenia gravis: Multicentric, hospital-based, and controlled study of 178 Italian patients. Neurol. Sci. 2024, 45, 3481–3494. [Google Scholar] [CrossRef]
- Hoefer, P.F.A.; Aranow, H.; Rowland, L.P. Myasthenia Gravis and Epilepsy. AMA Arch. Neurol. Psychiatry 1958, 80, 10–17. [Google Scholar] [CrossRef]
- Badurska, B.; Ryniewicz, B.; Kowalski, J. Epileptic seizures in children with myasthenia gravis. Neurol. Neurochir. Pol. 1991, 25, 326–331. [Google Scholar]
- Sureshbabu, S.; Karunanidhi, S.; Peter, S.; Chindrippu, S.; Joseph, M.; Mittal, G.K. Myasthenia gravis and insular cortex epilepsy: More than a chance association? Acta Neurol. Belg. 2022, 122, 1619–1621. [Google Scholar] [CrossRef]
- Lorenzoni, P.J.; Ducci, R.D.-P.; Tensini, T.S.; Dalledone, G.; Kay, C.S.K.; de Paola, L.; Werneck, L.C.; Scola, R.H.; Silvado, C. Treatment of epilepsy in patients with myasthenia gravis: Is really harder than it looks? J. Clin. Neurosci. 2017, 44, 353–356. [Google Scholar] [CrossRef]
- Hehir, M.K., 2nd; Li, Y. Diagnosis and Management of Myasthenia Gravis. Continuum 2022, 28, 1615–1642. [Google Scholar] [CrossRef]
- Fisher, R.S.; Acevedo, C.; Arzimanoglou, A.; Bogacz, A.; Cross, J.H.; Elger, C.E.; Engel, J., Jr.; Forsgren, L.; French, J.A.; Glynn, M.; et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014, 55, 475–482. [Google Scholar] [CrossRef]
- Fisher, R.S.; Cross, J.H.; French, J.A.; Higurashi, N.; Hirsch, E.; Jansen, F.E.; Lagae, L.; Moshé, S.L.; Peltola, J.; Roulet Perez, E.; et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017, 58, 522–530. [Google Scholar] [CrossRef] [PubMed]
- Steriade, C.; Britton, J.; Dale, R.C.; Gadoth, A.; Irani, S.R.; Linnoila, J.; McKeon, A.; Shao, X.; Venegas, V.; Bien, C.G. Acute symptomatic seizures secondary to autoimmune encephalitis and autoimmune-associated epilepsy: Conceptual definitions. Epilepsia 2020, 61, 1341–1351. [Google Scholar] [CrossRef] [PubMed]
- Ances, B.M.; Vitaliani, R.; Taylor, R.A.; Liebeskind, D.S.; Voloschin, A.; Houghton, D.J.; Galetta, S.L.; Dichter, M.; Alavi, A.; Rosenfeld, M.R.; et al. Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 2005, 128, 1764–1777. [Google Scholar] [CrossRef] [PubMed]
- Lai, C.-W.; Leppik, I.E.; Jenkins, D.C.; Sood, P. Epilepsy, Myasthenia Gravis, and Effect of Plasmapheresis on Antiepileptic Drug Concentrations. Arch. Neurol. 1990, 47, 66–68. [Google Scholar] [CrossRef] [PubMed]
- Koge, J.; Hayashi, S.; Murai, H.; Yokoyama, J.; Mizuno, Y.; Uehara, T.; Ueda, N.; Watanabe, O.; Takashima, H.; Kira, J.-I. Morvan’s syndrome and myasthenia gravis related to familial Mediterranean fever gene mutations. J. Neuroinflammation 2016, 13, 68. [Google Scholar] [CrossRef]
- Kurian, M.A.; King, M.D. Antibody Positive Myasthenia Gravis Following Treatment with Carbamazepine—A chance association? Neuropediatrics 2003, 34, 276–277. [Google Scholar] [CrossRef]
- Brumlik, J.; Jacobs, R.S. Myasthenia Gravis Associated with Diphenylhydantoin Therapy For Epilepsy. Can. J. Neurol. Sci. 1974, 1, 127–129. [Google Scholar] [CrossRef]
- Booker, H.E.; Chun, R.W.M.; Sanguino, M. Myasthenia Gravis Syndrome Associated With Trimethadione. JAMA 1970, 212, 2262–2263. [Google Scholar] [CrossRef]
- Schomburg, L. Selenium Deficiency Due to Diet, Pregnancy, Severe Illness, or COVID-19—A Preventable Trigger for Autoimmune Disease. Int. J. Mol. Sci. 2022, 22, 8532. [Google Scholar] [CrossRef] [PubMed]
- Liu, W.; Xu, J.; Zhang, L.; Li, F.; Zhang, L.; Tai, Z.; Yang, J.; Zhang, H.; Tuo, J.; Yu, C.; et al. Research progress on correlations between trace element levels and epilepsy. Front. Cell Dev. Biol. 2023, 11, 1167626. [Google Scholar] [CrossRef] [PubMed]
- Kürekçi, A.E.; Alpay, F.; Tanindi, Ş.; Gokçay, E.; Ozcan, O.; Akin, R.; Işimer, A.; Sayal, A. Plasma Trace Element, Plasma Glutathione Peroxidase, and Superoxide Dismutase Levels in Epileptic Children Receiving Antiepileptic Drug Therapy. Epilepsia 1995, 36, 600–604. [Google Scholar] [CrossRef] [PubMed]
- Hau Man, T.H.; Shek-Kwan, C.R.; On-Kei, C.A.; Lam, C.P.W. Effect of plasmapheresis on serum levels of clobazam, levetiracetam and topiramate. Epilepsy Behav. Case Rep. 2017, 8, 66–68. [Google Scholar] [CrossRef] [PubMed]
- Yang, Y.; Shen, Z.; Shi, F.; Wang, F.; Wen, N. Efgartigimod as a novel FcRn inhibitor for autoimmune disease. Neurol. Sci. 2024, 45, 4229–4241. [Google Scholar] [CrossRef] [PubMed]
- Di Stefano, V.; Alonge, P.; Rini, N.; Militello, M.; Lupica, A.; Torrente, A.; Brighina, F. Efgartigimod beyond myasthenia gravis: The role of FcRn-targeting therapies in stiff-person syndrome. J. Neurol. 2024, 271, 254–262. [Google Scholar] [CrossRef] [PubMed]
- Tröscher, A.R.; Mair, K.M.; Verdú de Juan, L.; Köck, U.; Steinmaurer, A.; Baier, H.; Becker, A.; Blümcke, I.; Finzel, M.; Geis, C.; et al. Temporal lobe epilepsy with GAD antibodies: Neurons killed by T cells not by complement membrane attack complex. Brain 2023, 146, 1436–1452. [Google Scholar] [CrossRef] [PubMed]
Patient nº | Sex (M/F) | Epilepsy Onset | MG Onset | Epilepsy Localization | Myasthenia Type | Epilepsy Etiology | MRI/FDG-PET | Epilepsy Semiology | ASDs | Myasthenia Treatment | Thymecmotized | RepStim | SFEMG | Antibodies | Related Conditions |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | F | 17 | 29 | Fronto-Temporal | Generalized IVb | Unknown | Nonlesional L. mesiotemporal h. | Warm sensation-FIAS | LEV, LCM | Eculizumab + Rituximab | Yes | Pathological | Pathological | AchR | |
2 | F | 25 | 40 | Right Fronto-central (Seizure recorded) | Generalized IIIa | Autoimmune | Nonlesional R. mesiotemporal h. | Hypersalivation-FIAS | CBZ | Mycophenolate mofetil + prednisone + IVIG | No | Pathological | Pathological | AchR, PR3, GAD low titers | PR3+ ANCA vasculitis |
3 | M | 11 | 25 | Bilateral fronto-central (Seizures recorded) | Generalized IIa | Post NORSE | Nonlesional | Anarthria+ sensation of auditory plugging FIAS | LCM, CLB BRV, CNB | Prednisone + azatioprine | Yes | Pathological | Pathological | AchR | N.O.R.S.E as debut |
4 | F | 41 | 46 | Left fronto-temporal | Ocular I | Autoimmune | Nonlesional | Nocturnal BTCS | VPA | No | No | Nonpathological | Not performed | GAD high titers | DM-LADA, Hypothyroidism |
5 | F | 16 | 50 | Focal (fronto-temporal) epilepsy | Generalized IIIa | Vascular | Fronto-temporo-parietal arteriovenous malformation | FAS (right arm clonias) | LEV LCM worsened myasthenia | Prednisone IVIG for relapses | Yes | Pathological | Not performed | AchR | Hypothyroidism |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Oyarzun, I.; Hernández, G.; Sala-Padró, J.; Morandeira, F.; Casasnovas, C.; Falip, M. Epilepsy and Myasthenia Gravis: A Case Series. Brain Sci. 2024, 14, 870. https://doi.org/10.3390/brainsci14090870
Oyarzun I, Hernández G, Sala-Padró J, Morandeira F, Casasnovas C, Falip M. Epilepsy and Myasthenia Gravis: A Case Series. Brain Sciences. 2024; 14(9):870. https://doi.org/10.3390/brainsci14090870
Chicago/Turabian StyleOyarzun, Iñigo, Guillermo Hernández, Jacint Sala-Padró, Francisco Morandeira, Carlos Casasnovas, and Mercè Falip. 2024. "Epilepsy and Myasthenia Gravis: A Case Series" Brain Sciences 14, no. 9: 870. https://doi.org/10.3390/brainsci14090870