[TRANSFORMATION OF MYASTHENIA GRAVIS INTO AMYOTROPHIC LATERAL SCLEROSIS, OR THEIR CONCOMITANCE? (CASE REVIEW)].

Area of Science:

• Neurology
• Immunology
• Pathogenesis

Background:

• Amyotrophic Lateral Sclerosis (ALS) and Myasthenia Gravis (MG) are distinct neurological disorders.
• Co-occurrence of ALS and MG is rare, with limited understanding of their potential pathogenetic links.
• Aberrant immune processes, including T-regulatory cell deficiency and autoantibodies, are implicated in both diseases.

Purpose of the Study:

• To investigate the possibility of pathogenetic comorbidity between Myasthenia Gravis and Amyotrophic Lateral Sclerosis.
• To highlight the importance of meticulous clinical analysis and diagnostic methods for accurate diagnosis and treatment.
• To explore potential shared immune system dysregulation in MG and ALS.

Main Methods:

• Case report of a 75-year-old male with diagnosed Myasthenia Gravis followed by Amyotrophic Lateral Sclerosis.
• Review of existing literature on the coexistence and pathogenetic associations of MG and ALS.
• Analysis of potential common immunological factors, including T-regulatory cells, atrogenes, nitric oxide synthase, and Heat Shock Protein 70 (HSP70) antibodies.

Main Results:

• The case presented typical clinical and electroneuromyographic signs of ALS, four years after an MG diagnosis.
• Shared immunological factors like T-regulatory cell deficiency and HSP70 antibody elevation in MG patients suggest a potential link.
• The 'dying-back' hypothesis suggests neuromuscular junction damage in MG might precede motor neuron loss, increasing ALS risk.

Conclusions:

• A common aberrant immune process may underlie the comorbidity of MG and ALS.
• Accurate diagnosis requires detailed clinical assessment and appropriate diagnostic tools, especially in complex cases.
• Further research into the pathogenetic mechanisms of both diseases is essential to determine if it's a transformation or coexistence.