Category: Other
Objective: To present a case of comorbid Parkinson’s disease(PD) and Myasthenia Gravis(MG) and review the literature about the underlying pathogenesis mechanisms and potential treatments.
Background: Coexistence of PD and MG is rare, and the subjacent mechanism is unknown. Some symptoms may overlap and the treatment adjustment can be challenging.
Method: We conducted a systematic on PubMed with “Parkinson’s disease” and “Myasthenia Gravis” along with a new case report from our center.
Results: A 76-year-old woman developed tremoric akinetic rigid syndrome at 66, consistent with idiopathic PD. Treatment included trihexyphenidyl(THP), pramipexole, rasagiline and levodopa. MG was diagnosed after 9 years, leading to THP withdrawal and pyridostigmine initiation, with tremor worsening. Despite adjusting levodopa dose, adding pregabalin and zonisamide, tremor persisted.
Conclusion: PD affects 6.1 million globally, and MG 2.4 per 100,000(1,2). Co-occurrence is rare, with limited cases reported since 1987(3). Most cases involve males aged 55-95, with PD preceding MG by 8 months to 20 years. Most MG cases start with ocular symptoms, and comorbid cases exhibit higher head drop incidence than each condition alone(4-10). Dysphagia, dysarthria and fatigue, common symptoms in PD and MG, are reported in comorbid cases(11-13).
The underlying mechanism is unknown(14), with uncertain overlap or age-related MG incidence increase in older PD patients(13). Initial hypotheses involve anticholinergic PD treatments like THP(15). Pyridostigmine may disturb the dopamine-acetylcholine balance, potentially causing parkinsonism. Unable to penetrate the blood-brain barrier, an altered barrier is hypothesized(16-18).
The hypothesis of immune pathogenesis arises from the documented associations of MG and PD with other autoimmune diseases(19-22). It is suggested that immune dysregulation triggers PD neurodegeneration, T cell dysregulation, and neuroinflammation induced by misfolded α -synuclein. LRRK2 mutations in PD might also imply immune regulation alteration(23-36).
Treatment evidence for comorbid MG and PD is scarce. Corticosteroids and pyridostigmine may worsen tremor, and antitremor medications may exacerbate MG symptoms.
Our case reflects the challenges of managing comorbid MG and PD, exploring shared symptoms, potential etiology and treatment difficulties.
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To cite this abstract in AMA style:
C. Sánchez-Rodríguez, I. Muro, E. Casas, P. Lorenzo, C. Sanabria, A. Somovilla, L. López. Parkinson’s disease and Myasthenia Gravis: a case report and literature review [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/parkinsons-disease-and-myasthenia-gravis-a-case-report-and-literature-review/. Accessed October 15, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-and-myasthenia-gravis-a-case-report-and-literature-review/