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Table 2 Characteristics, findings, treatments, and clinical outcome of reported Myasthenia gravis cases

From: Neuromuscular diseases associated with COVID-19 vaccines: a systematic review and pooled analysis of 258 patients

Variable

Sample size

n (%)

Age (year), Median (IQR)

22

64 (50, 74)

Gender, n (%) male

18 (82%)

Generalized Myasthenia Gravis

12 (55%)

mRNA-based vaccinea

1st dose / 2nd dose / Booster

14

5 (36%) / 5 (36%) / 4 (28%)

Vector-based vaccineb

1st dose / 2nd dose

8

7 (88%) / 1 (12%)

Presenting symptoms

Diplopia / Ptosisc / Dysarthria / Dysphagia / Extremity asthenia

13

10(77%)/ 6(46%)/ 3(23%)/ 3(23%)/ 1(8%)

Time from vaccine to symptom (days), Median (IQR)

22

6 (2, 8.5)

Tests

 Imaging

Normal Brain CT scan

5

5 (100%)

Normal Brain MRI

6

5 (83%)

Thymus hyperplasia on Chest CT scan

8

2 (25%)

 Tests in the clinic

Positive Ice pack test

2

2 (100%)

Positive IM neostigmine test

4

3 (75%)

 EMG

Positive RNS

15

13 (87%)

Positive SFEMG

4

4 (100%)

 Seropositivity

Only AChR Ab positive (MuSK not tested)

16

14 (87%)

AChR positive & MuSK negative

4

2 (50%)

 

AChR negative & MuSK negative

2 (50%)

Treatment

 Pyr only / + Pred / + IVIG / or + PLEX

19

7 (33%) / 7 (33%) / 1 (5%) / 1 (5%)

 Pyr + Pred + IVIG / Pyr + Pred + PLEX / Pred + PLEX

2 (10%) / 2 (10%) / 1 (5%)

Clinical outcomes

  

 Partial / Complete improvement at discharge or 1-month follow-up

14

7 (50%) / 4 (29%)

 Myasthenic crisis/symptoms unchanged at 3-months follow-up

2 (14%) / 1 (7%)

  1. AChR Acetylcholine Receptor antibody, CT Computed Tomography, EMG Electromyography, IM Intramuscular, IQR Interquartile range, IVIG Intravenous Immunoglobulin, MRI Magnetic Resonance Imaging, mRNA messenger Ribonucleic Acid, MuSK Muscle Specific Kinase antibody, PLEX Plasma Exchange, Pred Prednisolone, Pyr pyridostigmine, RNS Repetitive Nerve Stimulation, SFEMG Single Fiber Electromyography
  2. aPfizer or Spikevax, bAstraZeneca, call bilateral except patient #18, who had left-sided ptosis