Treatment of myasthenia gravis with dropped head: a report of 2 cases and review of the literature.
We report two patients with myasthenia gravis (MG) who showed dropped head as an early myasthenic manifestation. They had elevated anti-acetylcholine receptor antibody and showed improvement of the symptoms after intravenous injection of edorophonium chloride. One patient had thymoma and developed myasthenic crisis two weeks after thymectomy. The patient recovered from the crisis after a combination of immunoadsorption plasmapheresis (IAPP) and initiation of steroid and tacrolimus. The other patient without thymoma initiated treatment with steroid, tacrolimus and IAPP and showed complete recovery one month later. Dropped head in MG can recover well with immunosuppression therapy using steroid, and IAPP is helpful in getting a rapid improvement of dropped head as well as recovery from myasthenic crisis. When we consider treatment for MG with dropped head, we should take into account that MG of this type can develop myasthenic crisis and use the same treatment strategy as that for generalized MG.
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Michihiro
M
Tamai
Department of Neurology, Aizawa Hospital, Matsumoto, Japan. Electronic address: sinke-dr@ai-hosp.or.jp.
Takao
T
Hashimoto
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Takashi
T
Isobe
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Hiromasa
H
Sato
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Tadashi
T
Doden
Department of Neurology, Azumino Red Cross Hospital, Japan.
Takeshi
T
Nakano
D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies; D005260:Female; D006257:Head; D006801:Humans; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D010956:Plasmapheresis; D011950:Receptors, Cholinergic / Q000276:immunology; D016896:Treatment Outcome
D000906:Antibodies; D011950:Receptors, Cholinergic
Dropped head; Immunoadsorption plasmapheresis; Myasthenia gravis; Steroid