Myasthenia gravis complicated with autoimmune encephalitis: a review

This review aims to provide updated information about myasthenia gravis (MG) complicated with autoimmune encephalitis.

MG and autoimmune encephalitis are both antibody-mediated disorders with a need for active and individually adapted immunosuppressive treatment. The two disorders can co-exist. This represents therapeutic and diagnostic challenges but may help in elucidating disease mechanisms and risk factors.

A literature search combined the words "myasthenia gravis," "autoimmune encephalitis," and further combined each specific antibody associated with autoimmune encephalitis and "myasthenia gravis."

Epidemiological data and multiple single case reports illustrate the increased risk for autoimmune encephalitis in MG. The target antigens for the antibodies in both MG and autoimmune encephalitis vary among patients. Clinical manifestations, choice of therapy, and prognosis depend on antibody pattern. MG should be treated actively with immunosuppression according to updated and generally accepted guidelines. For treatment of autoimmune encephalitis, high corticosteroid doses, intravenous immunoglobulin (IVIg), plasma exchange, and rituximab should be considered. FcRn-blockers represent an additional option.

MG and autoimmune encephalitis have overlapping pathogenesis and similar preferred drug therapies. This comorbidity represents a therapeutic challenge, and often with the need of high-dose immunosuppressive combination therapy. New and targeted therapies are applied in some MG patients, and such therapies have relevance also for autoimmune encephalitis.