title: Worsening of myasthenia gravis after administration of injectable long-acting risperidone for treatment of schizophrenia; first case report and a call for caution.
abstract: Myasthenia gravis is an autoimmune disease characterized by muscle weakness due to autoantibodies affecting the neuromuscular junction. Co-occurrence of myasthenia gravis and schizophrenia is very rare and raises a challenge in management of both diseases. Antipsychotic drugs exhibit anticholinergic side effects and have the potentials of worsening myasthenia. Long-acting risperidone is an injectable atypical antipsychotic drug that has not been previously reported to worsen myasthenia gravis in literature. We report the first case report of worsening of myasthenia after receiving long-acting risperidone injection for schizophrenia in a 29-year-old female with both diseases. She started to have worsening 2 weeks following the first injection and her symptoms persisted despite receiving plasma exchange. This could be explained by the pharmacokinetics of the drug. We recommend that long-acting risperidone should be used with caution in patients with myasthenia gravis, and clinicians must be aware of the potential risks of this therapy.
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait.
authors.forename: Jasem Y
authors.initials: JY
authors.lastname: Al-Hashel
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait. Electronic address: dr.ismail.ibrahim2012@Gmail.com.
authors.forename: Ismail Ibrahim
authors.initials: II
authors.lastname: Ismail
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait.
authors.forename: John K
authors.initials: JK
authors.lastname: John
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Safat, Kuwait.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Kuwait Centre for Mental Health, Kuwait.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ali
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications* / Q000188:drug therapy; D018967:Risperidone / Q000008:administration & dosage* / Q000009:adverse effects*; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone
keywords: Crisis; Long-acting risperidone; Myasthenia; Risperidone; Schizophrenia