Amyotrophic Lateral Sclerosis and Myasthenia Gravis: Comorbidities and Differential Diagnosis

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Abstract

Amyotrophic lateral sclerosis (ALS) and myasthenia gravis (MG) are both characterized by primarily motor deficit, and their differential diagnosis may be sometimes challenging. We present a case report of a patient with late-onset ALS, which was initially misdiagnosed for anti-acetylcholine (anti-AChR) antibody-positive MG. In some cases, ALS has been thought to be triggered by MG. In the presented case report, elevated anti-AChR antibody titers (positive anti-AchR Ab) had no clinical significance and possibly indicated an immune response to structural changes in the postsynaptic membrane of the neuromuscular synapse in the ALS patient.

About the authors

Ekaterina V. Pervushina

Bashkir State Medical University

Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0000-0002-9352-5783

Cand. Sci. (Med.), Assistant Professor, Department of neurology

Russian Federation, Ufa

Mansur A. Kutlubaev

Bashkir State Medical University

Author for correspondence.
Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0000-0003-1001-2024

Dr. Sci. (Med.), Head, Department of neurology

Russian Federation, Ufa

Rim V. Magzhanov

Bashkir State Medical University

Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0000-0003-1246-4833

Dr. Sci. (Med.), Professor, Department of neurology

Russian Federation, Ufa

Maksim V. Brazhnikov

Republican Clinical Hospital named after G.G. Kuvatov

Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0009-0008-5959-388X

neurologist

Russian Federation, Ufa

Svetlana M. Farrakhova

Republican Clinical Hospital named after G.G. Kuvatov

Email: mansur.kutlubaev@yahoo.com
ORCID iD: 0009-0007-3890-264X

neurologist

Russian Federation, Ufa

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2. Fig. 1. Electromyogram of the patient N.

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3. Fig. 3. Periventricular hyperintensity of vascular origin on T2 (A) and FLAIR (B) MRI scans of the patient's brain.

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4. Fig. 2. Needle electromyogram of patient N. А — m. deltoideus dextra, average duration 13.3 ms (8.9–16.3 ms, ref. values < 12 ms), average amplitude 1408 µV (459–2164 µV, ref. values < 550 µV), spontaneous activity (single fibrillation and fasciculation potentials); B — m. interosseous I dextra, average duration 14 ms (9.9–17.8 ms, ref. values < 10.3 ms), average amplitude 4863 µV (2125–8427 µV, ref. values < 750 µV), and moderate spontaneous activity (fasciculation potentials).

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Copyright (c) 2024 Pervushina E.V., Kutlubaev M.A., Magzhanov R.V., Brazhnikov M.V., Farrakhova S.M.

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