Abstract
Aim: Myasthenia gravis (MG) is an autoimmune disease often caused by autoantibodies against postsynaptic acetylcholine receptors (AChR). It is known that vitamin D (VD), vitamin B12 and folic acid have some effects on the immune system. The aim of this study is to evaluate whether there is a difference in serum VD, vitamin B12 and folic acid levels in MG patients during the myasthenic crisis period compared to the non-crisis period.
 Material and Method: 32 patients followed up with the diagnosis of MG in Atatürk University Faculty of Medicine, Department of Neurology were included in the study. Serum 25(OH)D, vitamin B12 and folic acid levels were measured by taking blood from the antecubital vein in two different time periods, during the myasthenic crisis and during the non-crisis period, and periods were compared among themselves.
 Results: During the myasthenic crisis period, 25(OH)D level was 11.54 (1.08-50.33) ng/mL, vitamin B12 level was 299.5 (104-964) pg/mL, and folic acid level was 9.54±5.08 ng/mL. In the non-crisis period, 25(OH)D level was 18.74 (6.63-30.19) ng/mL, vitamin B12 level was 266 (119-678) pg/mL and folic acid level is 10.26±3.5 ng/mL. During the myasthenic crisis period, 25(OH)D vitamin levels of the patients were statistically significantly lower than the non-crisis period (p0.05).
 Conclusion: Low VD levels can be a facilitating factor in worsening myasthenic symptoms and entering myasthenic crisis. The use of VD supplements in MG patients with low VD levels may be beneficial in terms of protection from myasthenic crisis. Despite the limitations of our study, such as the small number of patients and the fact that 25(OH)D levels were not adjusted for seasonal effects, this study is the first study showing that VD levels are lower in the myasthenic crisis period than in the non-crisis period.
Highlights
Myasthenia gravis (MG) is a chronic autoimmune disease caused by autoantibodies that develop against postsynaptic acetylcholine receptors (AChR) frequently at the neuromuscular junction
The aim of this study is to evaluate whether there is a difference in serum vitamin D (VD), vitamin B12 and folic acid levels in MG patients during the myasthenic crisis period compared to the non-crisis period
Despite the limitations of our study, such as the small number of patients and the fact that 25(OH)D levels were not adjusted for seasonal effects, this study is the first study showing that VD levels are lower in the myasthenic crisis period than in the non-crisis period
Summary
Myasthenia gravis (MG) is a chronic autoimmune disease caused by autoantibodies that develop against postsynaptic acetylcholine receptors (AChR) frequently at the neuromuscular junction. Various degrees of muscle weakness that occurs and fluctuates in the ocular, bulbar muscles and extremity and respiratory muscles is the most important clinical feature of the disease. Myasthenic crisis may occur in some patients as the first manifestation of MG. The risk of myasthenic crisis is high in the first years of the disease. The risk of myasthenic crisis in patients with MG is 2-3% per year [1]. Conditions such as the use of certain drugs, infection, pregnancy, surgical operation, physical stress, discontinuation of immunosuppressive drugs or reducing their dose may cause myasthenic crisis in MG patients
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