Abstract TMP37: Occurrence of Myasthenia Gravis in Post Stroke Fatigue

Abstract

Background: Post stroke fatigue (PSF) is a common cause of poor quality of life after stroke. Mechanism of PSF is related to cortical dysfunction. Post stroke fatigue patients often demonstrate clinical fatigability of muscles. Objectives: We intend to study the frequency of seropositive myasthenia in the post stroke fatigue patients. Materials and methods: Retrospective analysis of the electronic medical records of follow up stroke patients with documented muscle fatigability and who had serum acetylcholine receptor antibody (AChR Ab)positivity was done. The demographic profile, comorbidities, auto immune disease, type of stroke,interval after stroke onset , muscle groups involved and response to cholinergic therapy were documented and analysed. Results: Of the 910 strokes, 132 had significant clinical fatigue after motor recovery, acetylcholine receptor antibody was positive(titre value>0.4 nmol/L) in 48(mean age 64.25 + 10.94, males 68%).Forty four had ischemic stroke rest had intra cerebral bleed. The major risk factors identified in these patients were hypertension (83.3%), diabetes mellitus(52.1%) and dyslipidemia (31.3%). The history of other autoimmune diseases was present in 29.5% (n=14).The major site of fatigability was the proximal muscles of the lower limb (97.8%), followed by shoulder muscles(68.8%), grip(77.1%), neck muscles(58.3%), bulbar(33.3%) and ocular(16.7%).The median time after stroke onset to fatigable weakness was 14.5 months (IQR 22.5).Data regarding thymoma was not available. Neostigmine test was positive for all the patients. Of the 46 patients treated with anticholinergics, all responded except one.Seven patients had mild adverse events and 4 patients discontinued treatment. Conclusion: Post stroke fatigue is a common morbidity and myasthenia could be a potentially treatable cause of fatigue after stroke.