Autoantibody-mediated neurological diseases

Question 1

What is myasthenia gravis and how to treat it?

Answer 1

• It is an autoantibody-mediated disease
• Led to the introduction of choline esterase inhibitors (ChEI) as treatment => increases availability of acetylcholine at the neuromuscular junction

Question 2

What is a thymectomy and is it effective against myasthenia gravis?

Answer 2

• Surgical removal of the thymus gland

- Effective in early onset MG

Question 3

What are the novel treatments for myasthenia gravis?

Answer 3

Mainly (but not only) antibodies against B-cells and plasma cells

Question 4

What is Rituximab and how does it affect myasthenia gravis?

Answer 4

• Monoclonal antibody
• Faster effect in new onset disease
• Faster and longer remission

Question 5

What is neuromyelitis optica

Answer 5

• Acute inflammation of the optic nerve caused by antibodies against aquaporin-4
• Treatment based on antibodies similar to myasthenia gravis treatment

Question 6

What is encephalitis, what causes it and what is affected/lost?

Answer 6

• Inflammation of the brain’s deeper structures
• Caused by antibodies (NMDA-encephalitis), but can be many other forms with different targets for autoantibodies
• Suggested that loss of synapses rather than neurons because brain can re-grow afterwards (if treated of course)

Question 7

What is narcolepsy and what causes it?

Answer 7

• Day time sleep attacks, disturbed night sleep
• Cataplexy: sudden loss of muscle tone (falls)
• Sleep paralysis
  => Caused by loss of hypocretin neurons

Question 8

Can vaccines caused serious side effects and is there any known risk factors?

Answer 8

• Neurological side effects may occur after vaccination but the risk is very low
• No known genetic or environmental risk factors (except narcolepsy after swine flu vaccination)