title: Single-fiber electromyography during menstrual exacerbation and ovulatory suppression in MuSK antibody-positive myasthenia gravis.
abstract: We report a patient with muscle-specific tyrosine kinase (MuSK) antibody-positive myasthenia gravis who experienced worsening of myasthenic weakness associated with alterations in estrogen and progesterone levels during the administration of oral contraceptive therapy. Single-fiber electromyography was performed to document changes in neuromuscular transmission associated with the clinical exacerbation and subsequent resolution of the menstrual exacerbation and clinical improvement experienced with continuous monophasic oral contraceptive therapy. The potential long-term benefit of ovulatory suppression in MuSK antibody-positive myasthenia gravis is discussed.
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina 29464, USA. stickle@musc.edu
authors.forename: David E
authors.initials: DE
authors.lastname: Stickler
authors.forename: Laura L
authors.initials: LL
authors.lastname: Stickler
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D000328:Adult; D001323:Autoantibodies / Q000276:immunology; D003278:Contraceptives, Oral, Hormonal / Q000494:pharmacology* / Q000627:therapeutic use; D004576:Electromyography; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000276:immunology*; D009119:Muscle Contraction / Q000187:drug effects / Q000276:immunology; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D018482:Muscle, Skeletal / Q000276:immunology / Q000294:innervation / Q000503:physiopathology; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D034445:Ovulation Inhibition / Q000276:immunology*; D011374:Progesterone / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D020794:Receptor Protein-Tyrosine Kinases / Q000276:immunology*; D011950:Receptors, Cholinergic / Q000276:immunology*; D009435:Synaptic Transmission / Q000187:drug effects / Q000276:immunology
chemical_list: D001323:Autoantibodies; D003278:Contraceptives, Oral, Hormonal; D011950:Receptors, Cholinergic; D011374:Progesterone; C095714:MUSK protein, human; D020794:Receptor Protein-Tyrosine Kinases; D000109:Acetylcholine