Abstract Body: Background:
Post-stroke fatigue is a common and debilitating issue, often linked to depression or neural damage. Emerging evidence suggests that myasthenia gravis (MG) may also play a role in post-stroke fatigue, offering a new perspective on patient management and long-term disability reduction.
Objectives:
This study aims to assess the incidence of de novo MG in stroke survivors following motor recovery over 18 to 24 months and compare findings with a healthy control group.
Methods:
Conducted at a tertiary care institution over two years, this prospective case-control study included ischemic and hemorrhagic stroke patients. Participants were recruited during the acute stroke phase and underwent evaluations for neuromuscular weakness and autoimmune disorders. They were monitored in a specialized stroke clinic for two years. Key variables included demographics, comorbidities, autoimmune disorders, stroke subtype, time since onset of stroke, and muscle fatigability. Age and sex-matched controls were assessed concurrently. Baseline and two-year follow-up measurements of acetylcholine receptor (AChR) antibodies were performed, and new antibodies were monitored. Participants with significant fatigability were tested for MG, and if confirmed, treated with cholinergic drugs.
Results:
The study involved 96 participants with a mean age of 60.45 years, predominantly male (63.86%). Ischemic stroke was most common (93.75%). Major risk factors included hypertension (12.5%), diabetes (5.20%), and dyslipidemia (3.12%), with 11.45% having autoimmune disorders. Of the 96 participants, 74 (77.08%) reported fatigability an average of 23.2 months post-stroke. Types of fatigability included neck (34.37%), proximal arm (11.46%), grip (19.80%), speech (5.21%), and eye (6.25%). Among 36 stroke patients with post-stroke fatigability and 36 controls re-evaluated at follow-up, 7 stroke patients tested positive for AChR antibodies compared to 1 control. Fisher’s Exact test showed a significant association between stroke and AChR-Ab positivity (p = 0.001), with an odds ratio of 7, suggesting a potential link between post-stroke fatigue and MG.
Conclusion:
The study highlights MG as a potential underrecognized factor in post-stroke fatigue. These findings may improve diagnostic and therapeutic strategies for stroke survivors and pave the way for further research into post-stroke immune alterations and MG development.