Myasthenia gravis: a review of available treatment approaches.

Patients with autoimmune myasthenia gravis (MG) should be further classified before initiating therapy, as treatment response varies for ocular versus generalised, early onset versus late onset, and acetylcholine receptor antibody positive versus MuSK antibody positive disease. Most patients need immunosuppression in addition to symptomatic therapy. Prednisolone and azathioprine represent first choice drugs, whereas several second choice options are recommended and should be considered.

Neurological effects of deep diving.

Deep diving is defined as diving to depths more than 50 m of seawater (msw), and is mainly used for occupational and military purposes. A deep dive is characterized by the compression phase, the bottom time and the decompression phase. Neurological and neurophysiologic effects are demonstrated in divers during the compression phase and the bottom time.

Chapter 41: the history of neurology in Scandinavia.

Neurology is well developed in Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) with a large number of clinical departments and specialists. The care for neurological patients is fairly equally organized even if neurology has evolved from different sources, from psychiatry in Denmark and Finland, internal medicine in Sweden and electrotherapy in Norway. Evidence of diagnostic activity and treatment of neurological diseases can be found in Scandinavia for more than 5000 years.

Myasthenia gravis in the elderly: Is it different?

We have defined myasthenia gravis (MG) in the elderly as onset after the age of 50 years. MG is diagnosed more often today than previously. The increase is mainly found in patients over the age of 50 years.

WHO/WFN Survey of neurological services: a worldwide perspective.

According to the findings obtained in the context of a Global Initiative on Neurology and Public Health carried out by the World Health Organization (WHO), there has been a lack of reliable and comparative data on services and other resources for neurological disorders in many parts of the world. In view of these findings and in collaboration with the World Federation of Neurology (WFN), WHO has recently organized an international Survey of Country Resources for Neurological Disorders, which involved 109 countries and covered over 90% of the world's population. This large WHO/WFN collaborative endeavour collected expert information on a number of aspects of neurological care provision around the world including availability of neurological services in primary care; human resources for neurological disorders; sub-specialized neurological services; primary method of financing of neurological care; and disability benefits for patients with neurological disorders.

Striational antibodies in myasthenia gravis: reactivity and possible clinical significance.

Myasthenia gravis is an autoimmune disease caused, in most cases, by antibodies attaching to the acetylcholine receptor. Some myasthenia gravis patients have antibodies that bind in a cross-striational pattern to skeletal and heart muscle tissue sections (striational antibodies). These antibodies react with epitopes on the muscle proteins titin and ryanodine receptor, are found mainly in sera of patients with thymoma and late-onset myasthenia gravis, and may correlate with myasthenia gravis severity.

The role of complement in myasthenia gravis: serological evidence of complement consumption in vivo.

Background: Antibodies to the acetylcholine receptor (AChR) titin and the ryanodine receptor (RyR) occur in myasthenia gravis (MG). These antibodies are capable of complement activation in vitro. The involvement of the complement system should cause consumption of complement components such as C3 and C4 in vivo.

[Intravenous immunoglobulin in postpolio syndrome].

Background: Postpolio syndrome is characterised by new muscular weakness, pain, and fatigue several decades after the acute polio, and affects approximately 1/4 of patients with previous paralytic polio.

Material And Methods: A 47-year-old woman with a previous history of acute poliomyelitis developed progressive muscular weakness in her left arm and right leg with muscular pain and fatigue. Clinical examination, MRI, and electromyography gave no other explanation to her progressive muscular weakness and fatigue than postpolio syndrome.

[Thymectomy and muscle antibodies in myasthenia gravis].

Background: Thymectomy as a treatment for myasthenia gravis (MG) is widely carried out as there is good clinical evidence for post-thymectomy improvement in younger MG patients.

Material And Methods: We examined the relationship between thymectomy, MG severity, the occurrence of muscle autoantibodies against acetylcholine receptor (AChR), titin, and ryanodine receptor (RyR), and pharmacological treatment in 52 early and 43 late-onset MG patients.

Results And Interpretation: Thymectomy in early-onset MG gave a rapid, highly significant, and long-lasting improvement during the first one to two years after surgery.

Lifestyle and late effects after poliomyelitis. A risk factor study of two populations.

Background: Patients with polio often experience new symptoms (muscle weakness, pain, fatigue and respiratory problems) many years after the acute disease. This study examined possible interactions between lifestyle factors (overweight, physical inactivity, smoking) and late polio with new symptoms.

Methods: A total of 148 patients hospitalized for acute polio in 1950-1954 at Haukeland University Hospital, Norway and 128 patients, hospitalized for acute polio in 1958 at Tartu University Hospital, Estonia responded to a mailed questionnaire regarding lifestyle and late polio with new symptoms.

[Skeletons in the cupboard--treatment of Arne Torkildsen].

Arne Torkildsen (1899-1968) developed Torkildsen's operation, the first successful shunt operation treating increased intraventricular pressure in the brain. He defended his doctoral thesis "Ventriculo-cisternostomy" in the University of Copenhagen in 1950, a thesis that had been rejected by the University of Oslo in his home country Norway. He was not found qualified for the post of associate professor in neurosurgery in spite of being recommended by two international adjudicating committees on four occasions.

Detection of viral sequences in archival spinal cords from fatal cases of poliomyelitis in 1951-1952.

Poliovirus (PV) subjected to genetic characterization is often isolated from faecal carriage. Such virus is not necessarily identical to the virus causing paralytic disease since genetic modifications may occur during replication outside the nervous system. We have searched for poliovirus genomes in the 14 fatal cases occurring during the last epidemics in Norway in 1951-1952.

Thymectomy and antimuscle antibodies in nonthymomatous myasthenia gravis.

The clinical effect of thymectomy in early- and late-onset myasthenia gravis (MG) and the correlation to MG severity, pharmacological treatment, and antimuscle antibodies were examined in two series of consecutive acetylcholine receptor (AChR) antibody-positive nonthymoma MG patients. The results indicate a benefit of thymectomy in early-onset MG, but no obvious clinical benefit in late-onset MG. The presence of muscle autoantibodies did not influence the outcome of thymectomy in early-onset MG.

Myasthenia gravis in individuals over 40.

Myasthenia gravis (MG) in individuals over 40 years of age comprises three groups: early-onset MG with prolonged disease duration, late-onset MG with thymoma, and late-onset of nonthymomatous MG. The clinical features do not differ between the three groups, except that early-onset patients with prolonged disease duration usually have a less severe disease. More than 60% of our MG patients are now more than 50 years of age, often with disease onset after age 40.

Pathogenesis of myositis and myasthenia associated with titin and ryanodine receptor antibodies.

Some myasthenia gravis (MG) patients have antibodies against skeletal muscle antigens in addition to the acetylcholine receptor (AChR). Two major antigens for these antibodies are the Ca(2+) release channel of the sarcoplasmic reticulum, the ryanodine receptor (RyR), and titin, a gigantic filamentous muscle protein essential for muscle structure, function, and development. RyR and titin antibodies are found in MG patients with a thymoma and in a proportion of late-onset MG, and they correlate with severe MG disease.

Role of cytokines in neurological disorders.

The balance between cytokines with pro- and anti-inflammatory effects contributes to the course of the Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. TNFalpha seems to be an important factor in the cascade of events leading to demyelination and even axonal damage. During the acute phase, the serum concentrations of TNFalpha and IL-6 are elevated while anti-inflammatory cytokines are up-regulated in the recovery phase.