Acquired neuromyotonia in thymoma-associated myasthenia gravis: a clinical and serological study

Matteo Gastaldi, Anna De Rosa, Michelangelo Maestri, Elisabetta Zardini, Silvia Scaranzin, Melania Guida, Paola Borrelli, Ottavia Eleonora Ferraro, Vito Lampasona, Roberto Furlan, Sarosh R Irani, Patrick Waters, Bethan Lang, Angela Vincent, Enrico Marchioni, Roberta Ricciardi, Diego Franciotta

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinic-prognostic significance of such comorbidity is largely unknown. We investigated clinic-pathologic features, along with the occurrence of neuromyotonia as predictors of tumor recurrence in patients with thymoma-associated myasthenia.

METHODS: We retrospectively studied 268 patients with thymomatous MG. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell-surface proteins and cell-based assays for CASPR2, LGI1, Glycine receptor, and Netrin-1 receptors antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography (EMG) abnormalities and/or autoantibodies against LGI1/CASPR2.

RESULTS: Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, 4 with typical autoantibodies, including LGI1 (n=1), CASPR2 (n=1), or both (n=2). Three patients had Netrin-1 receptors antibodies, 2 with neuromyotonia and concomitant CASPR+LGI1 antibodies, and 1 with spontaneous muscle overactivity without EMG evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than those without (28/263, 10%, p<0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy (odds ratio[OR]: 0.95, 95% confidence interval[CI] 0.93-0.97), Masaoka stage ≥IIb (OR:10.73, 95%CI:2.38-48.36), and neuromyotonia (OR: 41.78, CI:4.71-370.58).

CONCLUSIONS: De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumor recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG. This article is protected by copyright. All rights reserved.

LanguageEnglish
JournalEuropean Journal of Neurology
DOIs
Publication statusE-pub ahead of print - Feb 3 2019

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Acquired neuromyotonia in thymoma-associated myasthenia gravis : a clinical and serological study. / Gastaldi, Matteo; De Rosa, Anna; Maestri, Michelangelo; Zardini, Elisabetta; Scaranzin, Silvia; Guida, Melania; Borrelli, Paola; Ferraro, Ottavia Eleonora; Lampasona, Vito; Furlan, Roberto; Irani, Sarosh R; Waters, Patrick; Lang, Bethan; Vincent, Angela; Marchioni, Enrico; Ricciardi, Roberta; Franciotta, Diego.

In: European Journal of Neurology, 03.02.2019.

Research output: Contribution to journalArticle

Gastaldi, Matteo ; De Rosa, Anna ; Maestri, Michelangelo ; Zardini, Elisabetta ; Scaranzin, Silvia ; Guida, Melania ; Borrelli, Paola ; Ferraro, Ottavia Eleonora ; Lampasona, Vito ; Furlan, Roberto ; Irani, Sarosh R ; Waters, Patrick ; Lang, Bethan ; Vincent, Angela ; Marchioni, Enrico ; Ricciardi, Roberta ; Franciotta, Diego. / Acquired neuromyotonia in thymoma-associated myasthenia gravis : a clinical and serological study. In: European Journal of Neurology. 2019.
@article{30d78522159a493398e2c7d1456ce558,
title = "Acquired neuromyotonia in thymoma-associated myasthenia gravis: a clinical and serological study",
abstract = "BACKGROUND: Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinic-prognostic significance of such comorbidity is largely unknown. We investigated clinic-pathologic features, along with the occurrence of neuromyotonia as predictors of tumor recurrence in patients with thymoma-associated myasthenia.METHODS: We retrospectively studied 268 patients with thymomatous MG. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell-surface proteins and cell-based assays for CASPR2, LGI1, Glycine receptor, and Netrin-1 receptors antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography (EMG) abnormalities and/or autoantibodies against LGI1/CASPR2.RESULTS: Overall, 33/268 (12{\%}) MG patients had a thymoma recurrence. Five/268 (2{\%}) had neuromyotonia, 4 with typical autoantibodies, including LGI1 (n=1), CASPR2 (n=1), or both (n=2). Three patients had Netrin-1 receptors antibodies, 2 with neuromyotonia and concomitant CASPR+LGI1 antibodies, and 1 with spontaneous muscle overactivity without EMG evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80{\%}) than those without (28/263, 10{\%}, p<0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy (odds ratio[OR]: 0.95, 95{\%} confidence interval[CI] 0.93-0.97), Masaoka stage ≥IIb (OR:10.73, 95{\%}CI:2.38-48.36), and neuromyotonia (OR: 41.78, CI:4.71-370.58).CONCLUSIONS: De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumor recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG. This article is protected by copyright. All rights reserved.",
author = "Matteo Gastaldi and {De Rosa}, Anna and Michelangelo Maestri and Elisabetta Zardini and Silvia Scaranzin and Melania Guida and Paola Borrelli and Ferraro, {Ottavia Eleonora} and Vito Lampasona and Roberto Furlan and Irani, {Sarosh R} and Patrick Waters and Bethan Lang and Angela Vincent and Enrico Marchioni and Roberta Ricciardi and Diego Franciotta",
note = "This article is protected by copyright. All rights reserved.",
year = "2019",
month = "2",
day = "3",
doi = "10.1111/ene.13922",
language = "English",
journal = "European Journal of Neurology",
issn = "1351-5101",
publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Acquired neuromyotonia in thymoma-associated myasthenia gravis

T2 - European Journal of Neurology

AU - Gastaldi, Matteo

AU - De Rosa, Anna

AU - Maestri, Michelangelo

AU - Zardini, Elisabetta

AU - Scaranzin, Silvia

AU - Guida, Melania

AU - Borrelli, Paola

AU - Ferraro, Ottavia Eleonora

AU - Lampasona, Vito

AU - Furlan, Roberto

AU - Irani, Sarosh R

AU - Waters, Patrick

AU - Lang, Bethan

AU - Vincent, Angela

AU - Marchioni, Enrico

AU - Ricciardi, Roberta

AU - Franciotta, Diego

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/2/3

Y1 - 2019/2/3

N2 - BACKGROUND: Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinic-prognostic significance of such comorbidity is largely unknown. We investigated clinic-pathologic features, along with the occurrence of neuromyotonia as predictors of tumor recurrence in patients with thymoma-associated myasthenia.METHODS: We retrospectively studied 268 patients with thymomatous MG. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell-surface proteins and cell-based assays for CASPR2, LGI1, Glycine receptor, and Netrin-1 receptors antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography (EMG) abnormalities and/or autoantibodies against LGI1/CASPR2.RESULTS: Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, 4 with typical autoantibodies, including LGI1 (n=1), CASPR2 (n=1), or both (n=2). Three patients had Netrin-1 receptors antibodies, 2 with neuromyotonia and concomitant CASPR+LGI1 antibodies, and 1 with spontaneous muscle overactivity without EMG evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than those without (28/263, 10%, p<0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy (odds ratio[OR]: 0.95, 95% confidence interval[CI] 0.93-0.97), Masaoka stage ≥IIb (OR:10.73, 95%CI:2.38-48.36), and neuromyotonia (OR: 41.78, CI:4.71-370.58).CONCLUSIONS: De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumor recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinic-prognostic significance of such comorbidity is largely unknown. We investigated clinic-pathologic features, along with the occurrence of neuromyotonia as predictors of tumor recurrence in patients with thymoma-associated myasthenia.METHODS: We retrospectively studied 268 patients with thymomatous MG. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell-surface proteins and cell-based assays for CASPR2, LGI1, Glycine receptor, and Netrin-1 receptors antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography (EMG) abnormalities and/or autoantibodies against LGI1/CASPR2.RESULTS: Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, 4 with typical autoantibodies, including LGI1 (n=1), CASPR2 (n=1), or both (n=2). Three patients had Netrin-1 receptors antibodies, 2 with neuromyotonia and concomitant CASPR+LGI1 antibodies, and 1 with spontaneous muscle overactivity without EMG evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than those without (28/263, 10%, p<0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy (odds ratio[OR]: 0.95, 95% confidence interval[CI] 0.93-0.97), Masaoka stage ≥IIb (OR:10.73, 95%CI:2.38-48.36), and neuromyotonia (OR: 41.78, CI:4.71-370.58).CONCLUSIONS: De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumor recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG. This article is protected by copyright. All rights reserved.

U2 - 10.1111/ene.13922

DO - 10.1111/ene.13922

M3 - Article

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

ER -