{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:18:53Z","timestamp":1770351533460,"version":"3.49.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Myasthenia gravis (MG) is an autoimmune disorder in which the postsynaptic acetylcholine receptor of the neuromuscular junction is destroyed by autoantibodies. The authors report a case of MG in a pediatric patient who also suffered from Lennox-Gastaut syndrome (LGS) and is one of a limited number of pediatric patients who have undergone placement of a responsive neurostimulation (RNS) device (NeuroPace).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 17-year-old female underwent placement of an RNS device for drug-resistant epilepsy in the setting of LGS. Five months after device placement, the patient began experiencing intermittent slurred speech, fatigue, and muscle weakness. Initially, the symptoms were attributed to increased seizure activity and\/or medication side effects. However, despite changing medications and RNS settings, no improvements occurred. Her antiacetylcholine receptor antibodies measured 62.50 nmol\/L, consistent with a diagnosis of MG. The patient was then prescribed pyridostigmine and underwent a thymectomy, which alleviated most of her symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The authors share the cautionary tale of a case of MG in a pediatric patient who was treated with RNS for intractable epilepsy associated with LGS. Although slurred speech, fatigue, muscle weakness, and other symptoms might stem from increased seizure activity and\/or medication side effects, they could also be due to MG development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23334","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T19:13:26Z","timestamp":1701112406000},"source":"Crossref","is-referenced-by-count":1,"title":["Myasthenia gravis in a pediatric patient with Lennox-Gastaut syndrome following responsive neurostimulation device implantation: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"David A","family":"Zuckerman","sequence":"first","affiliation":[{"name":"New York Medical College, Valhalla, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron P","family":"Beaudreault","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie R","family":"Muh","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York"},{"name":"Department of Neurosurgery, Westchester Medical Center, Valhalla, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia E","family":"McGoldrick","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York"},{"name":"Department of Pediatrics, Division of Pediatric Neurology, Maria Fareri Children\u2019s Hospital, Valhalla, New York; and"},{"name":"Boston Children\u2019s Hospital Physicians, Hawthorne, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M","family":"Wolf","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York"},{"name":"Department of Pediatrics, Division of Pediatric Neurology, Maria Fareri Children\u2019s Hospital, Valhalla, New York; and"},{"name":"Boston Children\u2019s Hospital Physicians, Hawthorne, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Autoimmun","first-page":"143","article-title":"Diagnostic and clinical classification of autoimmune myasthenia gravis","volume":"48\u201349","author":"Berrih-Aknin S","year":"2014","unstructured":"Berrih-Aknin S, Frenkian-Cuvelier M, Eymard B. Diagnostic and clinical classification of autoimmune myasthenia gravis. J Autoimmun. 2014;48\u201349:143\u2013148."},{"issue":"3","key":"b2","series-title":"Neuroepidemiology","first-page":"171","article-title":"The incidence of myasthenia gravis: a systematic literature review","volume":"34","author":"McGrogan A","year":"2010","unstructured":"McGrogan A, Sneddon S, de Vries CS. The incidence of myasthenia gravis: a systematic literature review. Neuroepidemiology. 2010;34(3):171\u2013183."},{"issue":"18","key":"b3","series-title":"Neurology","first-page":"1548","article-title":"Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals","volume":"72","author":"Alshekhlee A","year":"2009","unstructured":"Alshekhlee A, Miles JD, Katirji B, Preston DC, Kaminski HJ. Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals. Neurology. 2009;72(18):1548\u20131554."},{"issue":"5","key":"b4","series-title":"JAMA Neurol","first-page":"569","article-title":"Population-level evidence for an autoimmune etiology of epilepsy","volume":"71","author":"Ong MS","year":"2014","unstructured":"Ong MS, Kohane IS, Cai T, Gorman MP, Mandl KD. Population-level evidence for an autoimmune etiology of epilepsy. JAMA Neurol. 2014;71(5):569\u2013574."},{"key":"b5","series-title":"J Clin Neurosci","first-page":"353","article-title":"Treatment of epilepsy in patients with myasthenia gravis: is really harder than it looks?","volume":"44","author":"Lorenzoni PJ","year":"2017","unstructured":"Lorenzoni PJ, Ducci RDP, Tensini TS,  Treatment of epilepsy in patients with myasthenia gravis: is really harder than it looks? 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Trends Neurosci. 2020;43(11):886\u2013901."},{"issue":"5","key":"b11","series-title":"Neurology","first-page":"1457","article-title":"Felbamate-associated fatal acute hepatic necrosis","volume":"46","author":"O\u2019Neil MG","year":"1996","unstructured":"O\u2019Neil MG, Perdun CS, Wilson MB, McGown ST, Patel S. Felbamate-associated fatal acute hepatic necrosis. Neurology. 1996;46(5):1457\u20131459."},{"issue":"6","key":"b12","series-title":"BMJ Open","first-page":"e007711","article-title":"Safety of lamotrigine in paediatrics: a systematic review","volume":"5","author":"Egunsola O","year":"2015","unstructured":"Egunsola O, Choonara I, Sammons HM. Safety of lamotrigine in paediatrics: a systematic review. 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Epilepsy Behav. 2022;129:108646."},{"issue":"11","key":"b10","series-title":"Trends Neurosci","first-page":"886","article-title":"16p11. 2 copy number variations and neurodevelopmental disorders","volume":"43","author":"Rein B","year":"2020","unstructured":"Rein B, Yan Z. 16p11. 2 copy number variations and neurodevelopmental disorders. Trends Neurosci. 2020;43(11):886\u2013901."},{"issue":"5","key":"b11","series-title":"Neurology","first-page":"1457","article-title":"Felbamate-associated fatal acute hepatic necrosis","volume":"46","author":"O\u2019Neil MG","year":"1996","unstructured":"O\u2019Neil MG, Perdun CS, Wilson MB, McGown ST, Patel S. Felbamate-associated fatal acute hepatic necrosis. Neurology. 1996;46(5):1457\u20131459."},{"issue":"6","key":"b12","series-title":"BMJ Open","first-page":"e007711","article-title":"Safety of lamotrigine in paediatrics: a systematic review","volume":"5","author":"Egunsola O","year":"2015","unstructured":"Egunsola O, Choonara I, Sammons HM. 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