Neuromyelitis Optica associated with Myastenia Gravis: A Case Report

Year 2024, Volume: 3 Issue: 1, 338 - 341, 29.03.2024

Selin Betaş Akın , Tutku Atay , Abdullah Güzel , Gökçe Zeytin Demiral , Ülkü Türk Börü

Abstract

Neuromyelitis optica (NMO, Devic syndrome) is an inflammatory, demyelinating central nervous system disorder typically associated with optic neuritis and transverse myelitis involving three or more segments in the spinal cord. Myasthenia Gravis (MG) is an autoimmune disease characterized by weakness in fatiguing muscles due to impaired neuromuscular transmission. NMO can coexist with autoimmune diseases, and its association with myasthenia gravis is common. Studies in existing patients with both NMO and MG support that MG symptoms often appear earlier and tend to be milder. Here, we present a case of a 45-year-old woman with concurrent NMO and MG, aligning with findings from previous studies.

Keywords

Demyelinating diseases, Neuromuscular diseases, Myasthenia Gravis, Devic disease

References

• 1. Wingerchuk, D.M., Weinshenker, B.G. Neuromyelitis optica. Curr Treat Options Neurol 10, 55–66 (2008). https://doi.org/10.1007/s11940-008-0007-z
• 2. Ratelade, Julien, and AS22713791 Verkman. “Neuromyelitis optica: aquaporin-4 based pathogenesis mechanisms and new therapies.” The international journal of biochemistry & cell biology 44.9 (2012): 1519-1530.)
• 3. Graber, David J., et al. “Neuromyelitis optica pathogenesis and aquaporin 4.” Journal of neuroinflammation 5.1 (2008): 1-21
• 4. Oflazer, Piraye, Durmuş-Tekçe, Hacer, & Deymeer, Feza. (2020, July 23). KAS VE NÖROMÜSKÜLER KAVŞAK HASTALIKLARI. Istanbul Tıp Fakultesi Nöroloji Anabilim Dalı. http://www.itfnoroloji.org/kas/kasindex3.htm
• 5. Zekeridou, Anastasia, and Vanda A. Lennon. “Aquaporin-4 autoimmunity.” Neurology-Neuroimmunology Neuroinflammation 2.4 (2015)
• 6. Z, Yan Y. Immunopathogenesis in Myasthenia Gravis and Neuromyelitis Optica. Front Immunol. 2017 Dec 12;8:1785. doi: 10.3389/fimmu.2017.01785. PMID: 29312313; PMCID: PMC5732908
• 7. Berrih-Aknin, Sonia. “Myasthenia Gravis: paradox versus paradigm in autoimmunity.” Journal of autoimmunity 52 (2014): 1-28.
• 8. Leite MI, Coutinho E, Lana-Peixoto M, et al. Myasthenia gravis and neuromyelitis optica spectrum disorder: a multicenter study of 16 patients. Neurology. 2012;78(20):1601-1607. doi:10.1212/WNL.0b013e31825644ff
• 9. McKeon A, Lennon VA, Jacob A, Matiello M, Lucchinetti CF, Kale N, et al. Coexistence of myasthenia gravis and serological markers of neurological autoimmunity in neuromyelitis optica. Muscle Nerve (2009) 39:87–90. 10.1002/mus.21197
• 10. Wang Z, Yan Y. Immunopathogenesis in Myasthenia Gravis and Neuromyelitis Optica. Front Immunol. 2017 Dec 12;8:1785. doi: 10.3389/fimmu.2017.01785. PMID: 29312313; PMCID: PMC5732908.
• 11. Vaknin-Dembinsky A, Abramsky O, Petrou P, Ben-Hur T, Gotkine M, Brill L, et al. Myasthenia gravis associated neuromyelitis optica like disease: an immunological link between the central nervous system and muscle. ArchNeurol (2011) 68:1557–61. 10.1001/archneurol.2011.200
• 12. Iyer A, Elsone L, Appleton R, Jacob A. A review of thecurrentliteratureand a guide to the early diagnosis of to immune disorders associated with neuromyelitis optica. Autoimmunity (2014) 47:154–61.10.3109/08916934.2014.883501
• 13. Jarius, S., et al. “Neuromyelitis optica spectrum disorders in patients with myasthenia gravis: ten new aquaporin-4 antibody positive cases and a review of the literature.” Multiple Sclerosis Journal 18.8 (2012): 1135-1143