title: Excessive daytime sleepiness in a patient with coexisting myotonic dystrophy type 1, myasthenia gravis and Graves' disease.
abstract: A 41-year-old female with history of Graves' disease, bilateral cataract, paroxysmal atrial fibrillation was admitted because of muscle weakness, daytime sleepiness, fatigability, drowsiness, bilateral eyelid ptosis, descending of head and lower jaw. On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). Electromyography revealed myopathic changes, myotonic and pseudomyotonic discharges, positive repetitive nerve stimulation test in proximal muscles. Myotonic dystrophy (MD) diagnosis was confirmed by genetic testing and myasthenia gravis (MG) by a positive titer of cholinergic receptor autoantibodies. In the CSF concentration of hypocretin was significantly decreased.
authors.affiliation: Department of Neurology, Medical University of Bialystok, Bialystok, Poland. Electronic address: katarzyna-kapica@wp.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kapica-Topczewska
authors.affiliation: Department of Neurology, Medical University of Bialystok, Bialystok, Poland. Electronic address: rpog@mp.pl.
authors.forename: Robert
authors.initials: R
authors.lastname: Pogorzelski
authors.affiliation: Department of Neurology, Medical University of Bialystok, Bialystok, Poland. Electronic address: amirtarasiuk@wp.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Tarasiuk
authors.affiliation: Department of Neurology, Medical University of Bialystok, Bialystok, Poland. Electronic address: drozdowski@cksr.ac.bialystok.pl.
authors.forename: Wiesław
authors.initials: W
authors.lastname: Drozdowski
authors.affiliation: Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-August-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: Piotr.Lewczuk@uk-erlangen.de.
authors.forename: Piotr
authors.initials: P
authors.lastname: Lewczuk
authors.affiliation: Department of Neurology, Medical University of Bialystok, Bialystok, Poland. Electronic address: alakul@umb.edu.pl.
authors.forename: Alina
authors.initials: A
authors.lastname: Kułakowska
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000235:genetics; D004576:Electromyography; D005260:Female; D005820:Genetic Testing; D006111:Graves Disease / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis; D009157:Myasthenia Gravis / Q000175:diagnosis* / Q000235:genetics; D009223:Myotonic Dystrophy / Q000175:diagnosis* / Q000235:genetics; D009460:Neurologic Examination; D011950:Receptors, Cholinergic / Q000276:immunology
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic
keywords: Graves’ disease; Hypocretin; Myasthenia gravis; Myotonic dystrophy