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Journal Information
Vol. 38. Issue 1.
Pages 61-62 (January - February 2023)
Vol. 38. Issue 1.
Pages 61-62 (January - February 2023)
Letter to the Editor
Open Access
Vitamin D and myasthenia gravis
Vitamina D y miastenia gravis
M. Larrosa-Domínguez
Universitat Rovira i Virgili, Departamento de Enfermería, Facultad de Enfermería, Tarragona, Spain
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Dear Editor:

I read with great interest the article published in Neurología under the title “Epidemiology of myasthenia gravis in the province of Ourense (Galicia, Spain),” which reports that 85.1% of patients diagnosed with myasthenia gravis (MG) present vitamin D deficiency (< 30ng/mL).1 In recent years, growing emphasis has been placed on the importance of vitamin D due to its influence in several processes, such as immunity. Vitamin D is known to play a significant role in the homeostasis of calcium and phosphorus, in the regulation of functional hormones, and in the activation of regulatory T cells and B cells.2

Kang et al.3 observed that serum vitamin D levels were significantly lower in patients with MG than in healthy controls. Furthermore, an improvement in muscle weakness has been observed after cholecalciferol supplementation in patients with low vitamin D levels.4 However, the most remarkable finding is the report of a patient showing remission of recurrent MG after administration of megadoses of vitamin D (80000–120000 IU/day).5 Nevertheless, megadoses are reported to be harmful to health due to an increase in the risk of falls, and consequently the rate of fractures.6 A recent randomised controlled trial did not observe a clinically significant improvement in patients treated with vitamin D with respect to those receiving placebo; however, the dose administered was 800 IU/day, which is much lower than that reported in previous studies.7

It is currently unclear whether low serum vitamin D levels are associated with a higher risk of MG, as has been described in other such diseases as multiple sclerosis.8 Therefore, further studies are needed on the influence of vitamin D on the onset and progression of MG. We should also mention that between 42% and 82% of patients with MG experience central fatigue; even patients in remission or with mild symptoms show mild fatigue.9,10 As central fatigue seems not to improve with immunosuppressant treatment, it is important to establish the role of vitamin D in the fatigue perceived by these patients.9 Therefore, I agree with Kang et al.3 in recommending that healthcare professionals monitor vitamin D levels in patients with MG in order to maintain optimal serum concentrations.


This study received no funding of any kind.

Conflicts of interest

The authors have no conflicts of interest to declare.

D.A. García, L.M. López, M. Pardo, G. Pérez, N.A. Sabbagh, G. Ozaita, et al.
Epidemiología de la miastenia gravis en la provincia de Ourense.
J.J. Gómez Piña.
Función de la vitamina D en la prevención de enfermedades.
Med Interna Mex, 36 (2020), pp. 68-76
S.Y. Kang, J.H. Kang, J.C. Choi, S.K. Song, J.H. Oh.
Low serum vitamin D levels in patients with myasthenia gravis.
J Clin Neurosci, 50 (2018), pp. 294-297
H. Askmark, L. Haggård, I. Nygren, A.R. Punga.
Vitamin D deficiency in patients with myasthenia gravis and improvement of fatigue after supplementation of vitamin D3: a pilot study.
Eur J Neurol, 19 (2012), pp. 1554-1560
F.A. Cadegiani.
Remission of severe myasthenia gravis after massive-dose Vitamin D treatment.
Am J Case Rep, 17 (2016), pp. 51-54
J. Quesada, M. Sosa.
Vitamina D y función muscular.
Rev Osteoporos Metab Min, 11 (2019), pp. 3-5
A. Okparasta, M.I. Indrasyah, H. Haddani, E. Bahar.
Effect of vitamin D3 supplementation towards vitamin D serum levels and Myasthenia Gravis Composite Score (MGCS).
J. Matías-Guíu, C. Oreja-Guevara, J.A. Matias-Guiu, U. Gomez-Pinedo.
Vitamin D and remyelination in multiple sclerosis.
Neurol, 33 (2018), pp. 177-186
A.M. Ruiter, J.J.G.M. Verschuuren, M.R. Tannemaat.
Fatigue in patients with myasthenia gravis. A systematic review of the literature.
Neuromuscul Disord, 30 (2020), pp. 631-639
C. Tran, V. Bril, H.D. Katzberg, C. Barnett.
Fatigue is a relevant outcome in patients with myasthenia gravis.
Muscle Nerve, 58 (2018), pp. 197-203
Copyright © 2022. Sociedad Española de Neurología
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