Efficacy and tolerability of subcutaneously administered immunoglobulin in myasthenia gravis: A systematic review.

Subcutaneous immunoglobulin (SCIg) is an emerging therapeutic alternative in the management of myasthenia gravis (MG) due to its potential efficacy, safety, cost effectiveness and ease of administration. At present, there are no systematic reviews that summarized the effects of SCIg in patients with MG. The objective of this study is to determine the efficacy and safety of SCIg in the treatment of adult patients with myasthenia gravis. Relevant records were identified from August 2018 to January 2019 systematic search. Five relevant articles with a total of 34 patients with MG were included in this review. Data on functional disability score and adverse events were obtained. Based on the included uncontrolled studies, the functional disability scores of adult MG patients after SCIg administration showed consistent improvement. Headache and local site injection reactions were the most common adverse events reported. The evidence from limited uncontrolled studies gathered in this review showed that SCIg may improve functional disability in patients with MG. Local and mild adverse events were reported with its administration, but no systemic and serious adverse events were noted.

Secondary hypokalemic paralysis with bulbar weakness and reversible electrophysiologic abnormalities: A case report and systematic review.

Hypokalemic periodic paralysis secondary to distal renal tubular acidosis presenting with prominent bulbar symptoms is extremely rare. The exact pathophysiology by which hypokalemia causes weakness is yet to be elucidated though muscle and nerve membrane hyperpolarization have been hypothesized. The pathophysiology of bulbar involvement in this condition is even more unclear. We report a case presenting as acute flaccid quadriplegia with prominent bulbar symptoms that reversed once potassium levels returned to normal. Serial nerve conduction studies were performed at various potassium levels revealing electrophysiologic abnormalities that corrected with potassium repletion. A systematic review of the literature was also conducted focusing on bulbar symptoms and electrophysiologic findings in hypokalemic periodic paralysis. Nerve conduction abnormalities in this condition are seldom documented, but reports have shown reduced amplitudes of compound motor action potentials and abnormal F-waves during acute attacks of hypokalemic paralysis.

A rare disease with a unique feature: Anti-NMDA receptor encephalitis and mesenteric teratoma

BACKGROUND: Antibodies to neuronal extracellular membrane antigens, including the NR1 subunit of the N-methyl-D-aspartate receptor, have been associated with neuropsychiatric symptoms. In 2003, the first case of anti-NMDA receptor encephalitis was identified in a young woman with subacute onset of ehavioural changes and seizures. OBJECTIVES: The aim of this case report is to describe the clinical features, disease course and management of a documented case of anti-NMDA receptor encephalitis in the Philippines. It also aims to highlight a unique feature of the disease as seen in the patient. CASE DESCRIPTION: The patient is a 36-year-old female with no known co-morbidities presenting with subacute onset of ehavioural change and generalized seizures. She was initially worked-up for viral encephalitis but the diagnostic tests were negative. With a suspicion of anti-NMDA receptor encephalitis, a search was made for the presence of a teratoma. This was confirmed by imaging studies and subsequent surgical resection of an immature mesenteric teratoma was done. Immunohistochemical assay of both blood and CSF were positive for NMDAR antibodies. CONCLUSION: This is the first confirmed case of anti-NMDA receptor encephalitis reported in the Philippines. It has the unique feature of being associated with an immature mesenteric teratoma, a finding that has not been reported in literature. The possibility of anti-NMDAR encephalitis need to be considered among patients with subacute onset of ehavioural changes and seizures when usual diagnostic tests for the more common etiologies prove negative.