Displaying publications 1 - 20 of 30 in total

  1. Finsterer J, Scorza CA, Scorza FA, Fiorini AC
    Med J Malaysia, 2020 07;75(4):409-410.
    PMID: 32724005
    No abstract provided.
    Matched MeSH terms: Myasthenia Gravis*
  2. Rattanathamsakul N, Siritho S, Viswanathan S, Hiew FL, Apiwattanakul M, Tan K, et al.
    J Clin Apher, 2023 Aug;38(4):437-446.
    PMID: 36896493 DOI: 10.1002/jca.22047
    INTRODUCTION: Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region.

    METHOD: A questionnaire-based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center.

    RESULTS: A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add-on treatment in steroid-refractory cases or as first-line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post-TPE relapse rates, and TPE-related complications. The major challenges within our region are expense, reimbursibility, and access to TPE.

    CONCLUSION: Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.

    Matched MeSH terms: Myasthenia Gravis/therapy
  3. Hamid FA, Hasbullah AHH, Ban AY
    Breathe (Sheff), 2020 Dec;16(4):200065.
    PMID: 33447285 DOI: 10.1183/20734735.0065-2020
    Can you diagnose this patient with recurrent pneumonia and myasthenia gravis? https://bit.ly/2IBaxC1.
    Matched MeSH terms: Myasthenia Gravis
  4. Cheo SW, Low QJ, Mow WC, Chia YK
    QJM, 2019 May 01;112(5):381-382.
    PMID: 30517761 DOI: 10.1093/qjmed/hcy284
    Matched MeSH terms: Myasthenia Gravis/complications; Myasthenia Gravis/diagnosis*
  5. Lim Say Wan, Gunendran A
    Med J Malaya, 1969 Dec;24(2):128-37.
    PMID: 4244138
    Matched MeSH terms: Myasthenia Gravis*
  6. Benjamin NHS, Gin TH, Ling Elora OY, Yung Kelly WK
    J R Coll Physicians Edinb, 2022 Mar;52(1):30-33.
    PMID: 36146975 DOI: 10.1177/14782715221088914
    Bilateral medial medullary stroke is a rare stroke syndrome. The clinical presentation of bilateral medial medullary stroke is heterogenous and often overlaps with other non-stroke neurology emergencies such as Guillain-Barrésyndrome, myasthenic crisis and acute vestibular syndrome, leading to misdiagnosis. We wish to present a case of a young lady with type 1 diabetes mellitus, who had presented with subacute neuromuscular weakness which was erroneously treated as myasthenic crisis. Her case was subsequently diagnosed as bilateral medial medullary stroke, following evolving clinical signs and magnetic resonance imaging (MRI) findings of a heart-shaped abnormality at the rostral medulla. This rare stroke syndrome represented a diagnostic challenge which necessitated a strong clinical suspicion and an urgent MRI scan of the brain for prompt diagnosis to enable appropriate treatment initiation.
    Matched MeSH terms: Myasthenia Gravis*
  7. Tan TL, Tan HJ, Cheah CF, Kumaresh R, Azzahra NA
    Med J Malaysia, 2020 05;75(3):295-297.
    PMID: 32467548
    Recurrent pneumonia warrants a diligent work-up to identify the underlying cause that perpetuates the disease process. Insidious bulbar dysfunction is arguably the most devastating as it would be diagnosed late after significant pulmonary complications due to chronic micro-aspiration. Bulbar disorder should be considered as the potential aetiology of recurrent pulmonary infections in the young population after excluding immunodeficiency disorder and respiratory anatomical anomaly. This report illustrates a rare case of bulbar onset myasthenia gravis which manifested as focal bronchiolectasis due to recurrent undiagnosed aspiration pneumonia three years earlier. Absence of hallmark features of Myasthenia Gravis (MG) such as ptosis, opthalmoplegia and proximal muscle weakness contributed to the diagnostic delay and challenges in this case. The diagnosis was established with the collaboration of multidisciplinary teams. Subsequent correct therapeutic interventions resulted in remarkable recovery in functional status and prevented her from further aspiration in the long run.
    Matched MeSH terms: Myasthenia Gravis/diagnosis*; Myasthenia Gravis/drug therapy*; Myasthenia Gravis/etiology
  8. Muhammed J, Chen CY, Wan Hitam WH, Ghazali MZ
    Malays J Med Sci, 2016 Jul;23(4):71-8.
    PMID: 27660548 MyJurnal DOI: 10.21315/mjms2016.23.4.10
    A thymectomy is considered effective for patients with myasthenia gravis (MG). Although a few studies have described the role of a thymectomy in the treatment of MG in Asians countries, there are no published data on the application of this surgical approach for MG in Malaysia. We aimed to describe the clinical outcomes of MG patients who underwent a thymectomy and the factors affecting these outcomes.
    Matched MeSH terms: Myasthenia Gravis
  9. Masra F, Ishak S, Cheah FC
    Turk J Pediatr, 2023;65(2):321-325.
    PMID: 37114697 DOI: 10.24953/turkjped.2022.717
    BACKGROUND: Transient neonatal myasthenia gravis (TNMG) is an acquired disease which occurs in 10 to 20% of infants born to a mother with myasthenia gravis. Even though it is a self-limiting disorder, it may potentially be life-threatening if prompt diagnosis is not made, and expedient supportive respiratory management is not initiated when required.

    CASE: Here we describe three infants with TNMG. Two of them developed symptoms of TNMG within 24 hours of life, but one developed symptoms at 43 hours of life. One of the patients had an atypical form of TNMG with contracture and hypotonia. The other two infants survived a typical form of TNMG with hypotonia and poor sucking. All cases resolved spontaneously by one to two weeks of life with conservative management.

    CONCLUSIONS: Infants born to mothers with myasthenia gravis need to be monitored closely for symptoms of TNMG for the first 48 to 72 hours of life. However, the majority of infants with TNMG traverse a benign course and resolve spontaneously with expectant care.

    Matched MeSH terms: Myasthenia Gravis, Neonatal*
  10. Wong KH, Yong MH, Mohd Khialdin S, Wan Abdul Halim WH
    Optom Vis Sci, 2023 Dec 01;100(12):895-899.
    PMID: 38019959 DOI: 10.1097/OPX.0000000000002089
    SIGNIFICANCE: Determining the anatomic location of insult in cases of concurrent bilateral upgaze palsy with bilateral ptosis can be challenging because of the various overlapping pathways and shared functions. It is more commonly related to bilateral oculomotor nerve palsies and myasthenia gravis. However, the possibility of unilateral cerebrovascular events may be overlooked because of the lack of laterality of disease manifestations.

    PURPOSE: This report documents the uncommon presentation of bilateral ptosis and upgaze palsy in unilateral hemispheric hemorrhage with the corresponding clinical and anatomical review.

    CASE REPORT: A 46-year-old gentleman presented to the emergency department with left-sided hemiplegia, concurrent bilateral ptosis, and upgaze palsy. He was found to have acute hemorrhagic stroke secondary to significantly elevated blood pressure. Computed tomography of the brain revealed acute extensive intraparenchymal hemorrhage involving the right basal ganglia, frontal lobe, and temporal lobe. There was an extension of hemorrhage into the third ventricle and subarachnoid extension to the Sylvian fissure with obstructive hydrocephalus. An emergency right craniotomy was performed to evacuate the blood clot, and the hydrocephalus subsequently resolved. Post-operatively, bilateral ptosis and upgaze palsy improved and then resolved.

    CONCLUSIONS: Acute bilateral ptosis and upgaze palsy suggest the possibility of unilateral hemispheric hemorrhage, even though there is no direct involvement of the brainstem and its nuclei.

    Matched MeSH terms: Myasthenia Gravis*
  11. Hamizah R, Norlinah MI, Tan HJ, Soehardy Z, Halim AG, Rohana AG, et al.
    Med J Malaysia, 2006 Dec;61(5):633-5.
    PMID: 17623968 MyJurnal
    A 20-year-old girl first notice bilateral ocular muscle weakness in 2001. Two months later, she developed acute muscle paralysis and respiratory failure which required ventilation. Serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation test was positive and consistent with myasthenia gravis (MG). CT scan thorax revealed thymic enlargement and she underwent a video assisted thymectomy (VATS). However, over the next three years, despite maximal doses of various immunosuppressive agents with plasmapheresis and intravenous immunoglobulin, she was admitted with recurrent myasthenic crisis without any obvious precipitant. She was then commenced on mycophenolate mofetil and together with regular plasmapheresis, cyclosporine and prednisolone, her symptoms have finally improved and brought under control.
    Matched MeSH terms: Myasthenia Gravis/diagnosis; Myasthenia Gravis/drug therapy; Myasthenia Gravis/surgery*
  12. Tan CT, Loh TG
    Med J Malaysia, 1980 Dec;35(2):144-9.
    PMID: 7266408
    A retrospective study of 62 cases of myasthenia gravis in Malaysia is reviewed. It shows an apparent prevalence among the ethnic Chinese compared with the Malay and Indian. The incidence of male and female and their average age of onset are similar. Unlike the western figure, among those with age of onset less than 20 years. both sexes are equally affected. The symptomatology, morbidity and mortality and incidence of thymoma are the same as those
    reported elsewhere.
    Matched MeSH terms: Myasthenia Gravis/epidemiology*; Myasthenia Gravis/therapy
  13. Payus AO, Leow Wen Hsiang J, Leong JQ, Ibrahim A, Raymond AA
    Am J Case Rep, 2021 Jan 20;22:e928419.
    PMID: 33468985 DOI: 10.12659/AJCR.928419
    BACKGROUND Myasthenic crisis is a condition characterized by the sudden onset of myasthenic weakness involving the respiratory muscles and requires ventilatory support to prevent death. This is a case report of respiratory failure in a 43-year-old man as the first presentation of myasthenia gravis. CASE REPORT A 43-year-old man with underlying hypertension and a lacunar stroke with good muscle-power recovery presented with severe community-acquired pneumonia, complicated with respiratory failure requiring invasive ventilatory support. He responded well to the intravenous antibiotic therapy and after 1 week of treatment, he was hemodynamically stable and his septic parameters improved. However, he persistently failed to maintain adequate spontaneous respiratory effort after the removal of the ventilatory support and had to be reintubated multiple times. There was no other identifiable cause for the worsening respiratory failure. He had no clinical features or muscle weakness suggestive of myasthenia gravis. However, his blood test was positive for serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation tests showed the characteristic decremental response of compound muscle action potential amplitude, in keeping with the diagnosis of myasthenia gravis. He responded well to intravenous immunoglobulin and was discharged with anticholinesterase inhibitors and long-term immunosuppression therapy. CONCLUSIONS This report demonstrates that when patients are admitted to the hospital with acute respiratory failure without any underlying pulmonary disease and with weakness of the respiratory muscles, the diagnosis of myasthenia gravis presenting with a myasthenic crisis should be considered.
    Matched MeSH terms: Myasthenia Gravis/diagnosis*; Myasthenia Gravis/drug therapy
  14. Heng HS, Lim M, Absoud M, Austin C, Clarke D, Wraige E, et al.
    Neuromuscul Disord, 2014 Jan;24(1):25-30.
    PMID: 24239058 DOI: 10.1016/j.nmd.2013.09.013
    Most evidence supporting the benefit of thymectomy in juvenile myasthenia gravis (JMG) is extrapolated from adult studies, with only little data concerning paediatric populations. Here we evaluate the outcome of children with generalized JMG who underwent thymectomy between 1996 and 2010 at 2 tertiary paediatric neurology referral centres in the United Kingdom. Twenty patients (15 female, 5 male), aged 13months to 15.5years (median 10.4years) at disease onset, were identified. Prior to thymectomy, disease severity was graded as IIb in 3, III in 11, and IV in 6 patients according to the Osserman classification. All demonstrated positive anti-acetylcholine receptor (AChR) antibody titres. All patients received pyridostigmine and 14 received additional steroid therapy. Transternal thymectomy was performed at the age of 2.7-16.6years (median 11.1years). At the last follow-up (10months to 10.9years, median 2.7years, after thymectomy), the majority of children demonstrated substantial improvement, although some had required additional immune-modulatory therapies. About one third achieved complete remission. The postoperative morbidity was low. No benefit was observed in one patient with thymoma. We conclude that thymectomy should be considered as a treatment option early in the course of generalised AChR antibody-positive JMG.
    Matched MeSH terms: Myasthenia Gravis/immunology; Myasthenia Gravis/surgery*
  15. Kim YJ
    J Acupunct Meridian Stud, 2017 Aug;10(4):290-293.
    PMID: 28889846 DOI: 10.1016/j.jams.2017.05.003
    Myasthenia gravis (MG) is an acquired disease of the neuromuscular junctions characterized by muscular weakness and fatigue, with a prevalence of 50-125 cases per million population in western countries. In men, it usually appears after the age of 60 years, while in women, it usually appears before the age of 40 years. Long-term immunosuppression with corticosteroids is the mainstay treatment for patients with MG; however, the use of corticosteroids is a well-documented risk factor for type 2 diabetes mellitus, which has also been reported in steroid-treated patients with MG. Here, a case of type 2 diabetes mellitus in a patient with MG who underwent 105 sessions of acupuncture delivered over 6 months is reported. After acupuncture treatment, the patient's fasting plasma glucose and hemoglobin A1c levels, as well as the score on the Hamilton Depression Rating Scale, were decreased. Furthermore, no adverse effects were observed. The findings in this clinical study are encouraging and provide evidence supporting the effectiveness of acupuncture in reducing type 2 diabetes mellitus in a patient with MG.
    Matched MeSH terms: Myasthenia Gravis/complications*; Myasthenia Gravis/therapy*
  16. Krishna L, Abdul Jalil NF, Lott PW, Singh S, Choo MM
    Eur J Ophthalmol, 2021 Mar;31(2):NP119-NP122.
    PMID: 31390886 DOI: 10.1177/1120672119867605
    PURPOSE: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation.

    METHOD: A case series.

    RESULTS: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis.

    CONCLUSION: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

    Matched MeSH terms: Myasthenia Gravis/diagnosis*; Myasthenia Gravis/drug therapy; Myasthenia Gravis/genetics
  17. Yousuf UA, Yashodhara BM, Thanigasalam T, Ting HS
    BMJ Case Rep, 2014 May 02;2014.
    PMID: 24792021 DOI: 10.1136/bcr-2013-203488
    A 58-year-old man presented with diplopia and partial ptosis for 10 years. It was non-progressive in nature, despite inadequate medical attention the patient received from non-specialists/general practitioners. He did not have fatigability or diurnal variation in weakness and was clinically stable without exacerbations of disease for a decade. He did not have features of Graves's disease, oculopharyngeal dystrophy, cranial nerve paralysis, polymyositis and stroke. The possibility of an atypical presentation of myasthenia gravis (MG) was considered and the patient was evaluated. Ice pack test was negative, Cogan's lid twitch (CLT) test was positive and high titres of acetylcholine receptor antibodies (AChR Ab) suggestive of MG were found. He was treated accordingly with a very good response.
    Matched MeSH terms: Myasthenia Gravis/complications; Myasthenia Gravis/diagnosis*; Myasthenia Gravis/drug therapy
  18. Tan SS, Latif SA, Poh WY
    Med J Malaysia, 2012 Jun;67(3):323-5.
    PMID: 23082426 MyJurnal
    Penicillamine toxicity in Wilson's disease has been well reported but rarely seen now as newer agents are being used. We present a case who developed multiple rare complications of Penicillamine concurrently. Our patient is one of three siblings on Penicillamine, she was the only one who developed massive breast enlargement four months after commencing Penicillamine therapy, as well as dermatological adverse reactions and myasthenia gravis three more months later. All the adverse effects improved soon after substitution of the offending agent with Trientine.
    Matched MeSH terms: Myasthenia Gravis/chemically induced*
  19. Chuah SY, Wong NW, Goh KL
    Postgrad Med J, 1997 Mar;73(857):177-9.
    PMID: 9135840 DOI: 10.1136/pgmj.73.857.177
    Matched MeSH terms: Myasthenia Gravis/chemically induced
  20. Angelopoulou E, Paudel YN, Piperi C
    ACS Chem Neurosci, 2020 03 04;11(5):663-673.
    PMID: 32017530 DOI: 10.1021/acschemneuro.9b00678
    Myasthenia gravis (MG) is an autoimmune T cell-dependent B cell-mediated disorder of the neuromuscular junction (NMJ) characterized by fluctuating skeletal muscle weakness, most commonly attributed to pathogenic autoantibodies against postsynaptic nicotinic acetylcholine receptors (AChRs). Although MG pathogenesis is well-documented, there are no objective biomarkers that could effectively correlate with disease severity or MG clinical subtypes, and current treatment approaches are often ineffective. The receptor for advanced glycation end products (RAGE) is a multiligand cell-bound receptor highly implicated in proinflammatory responses and autoimmunity. Preclinical evidence demonstrates that RAGE and its ligand S100B are upregulated in rat models of experimental autoimmune myasthenia gravis (EAMG). S100B-mediated RAGE activation has been shown to exacerbate EAMG, by enhancing T cell proinflammatory responses, aggravating T helper (Th) subset imbalance, increasing AChR-specific T cell proliferative capacity, and promoting the production of antibodies against AChRs from the spleen. Soluble sRAGE and esRAGE, acting as decoys of RAGE ligands, are found to be significantly reduced in MG patients. Moreover, MG has been associated with increased serum levels of S100A12, S100B and HMGB1. Several studies have shown that the presence of thymic abnormalities, the onset age of MG, and the duration of the disease may affect the levels of these proteins in MG patients. Herein, we discuss the emerging role of RAGE and its ligands in MG immunopathogenesis, their clinical significance as promising biomarkers, as well as the potential therapeutic implications of targeting RAGE signaling in MG treatment.
    Matched MeSH terms: Myasthenia Gravis, Autoimmune, Experimental*
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