#32) INDEX CASE OF IMPROVEMENT OF MYASTHENIA GRAVIS WITH VITAMIN D NOW VERIFIED WITH A FORMAL RESEARCH STUDY

On May 14, 2011, I posted #19) CASE HISTORY: SUBJECTIVE AND OBJECTIVE IMPROVEMENT IN MYASTHENIA GRAVIS FOLLOWING AGGRESSIVE TREATMENT OF VITAMIN D INSUFFICIENCY. I wrote about Debbie, a lady who was diagnosed with MG at age 41 in 2001. http://robertbakermdhealthnewsletter.blogspot.com/2011/05/case-history-subjective-and-objective.html

I first saw her in November, 2008 when she was on a high dose of prednisone for her disease, and also had vitamin D insufficiency diagnosed with a blood level. It made sense that MG should respond to vitamin D. It is a disease caused by production of abnormal antibodies that attack receptors located between muscles and nerves. I had previously searched MEDLINE and the internet using several search engines and was unable to find any research study or case history reporting on a connection. There simply were none. So I told Debbie we need to treat her vitamin D insufficiency to treat and improve her osteoporosis promoted by the steroids. I added that if there was a positive effect on her illnesses, that would be a bonus. I wrote up the response that Debbie had in the above mentioned Health Letter.

In mid-2012 I saw patient Sara who was 27 and had been diagnosed with myasthenia gravis the previous year,
confirmed by special tests. She had been advised by her neurologist to have her thymus gland removed, a procedure
that often helps relieve symptoms of myasthenia gravis. (It is felt that myasthenia gravis is caused by antibodies that are produced by the thymus gland, which is a gland in the neck related to the immune system.) She was holding off on the final decision.

At that time her 25-hydroxyvitamin D level was low. I discussed with her the treatment of vitamin D deficiency, the experience of my patient Debbie, and the possible beneficial effect it can have on myasthenia gravis. She started 5000 units of vitamin D with instructions for getting up follow up levels.

I saw Sara again about a year later. She had not had any surgery. Her symptoms were 80% improved. No change was made from a year before except the addition of 5000 units of vitamin D. She has given me her kind permission to use her first name in this write-up of her case.

Three months before seeing Sara a second time, a group of neurologists from Sweden published a study in the European Journal of Neurology (December 19, 2012). They studied 33 patients with MG. 13 patients were started on Vitamin D 800 units a day with a follow up an average of 6 months later. Neurologists use an objective test called the MGC
to measure the severity of fatigue with MG. (Fatigue is a prominent symptoms of MG). The MGC score in the 800 Unit vitamin D taking subjects improved 38%.

I emailed one of the authors and supplied to her the link of the case history report involving Debbie. She responded by telling me another doctor had shared with them a similar case also using 5000 units of vitamin D daily. She indicated that her group was planning further studies involving a dose close to what Debbie and this other case she heard about received.

The Swedish study was published in December. 2012. Up to that point no study had been published in a medical journal regarding the use of vitamin D to treat MG. The case report on Debbie that I published on my internet health letter represents the first case report ever published anywhere on the subject. My 2 case studies had far more than 38% improvement, but the dose I used was much higher than the 800 units used in Sweden.

My 2 case histories using 5000 units of vitamin D (and the Swedish study showing lesser improvement with 800 units) leads to the following recommendations that apply to every patient with MG:

1. Every MG patient should receive a 25-hydroxyvitamin D test (it will be low), and have the insufficiency treated, preferable to a level of 50 to 80 ng (125 to 200 nM.) (Treatment of vitamin D insufficiency is already recommended by vitamin D experts for the prevention of osteoporosis and other illnesses).

2. Other treatments for MG may need to be given as should be determined by the patient’s neurologist. However if the improvement is substantial enough, other treatments may not be necessary.