Juvenile myasthenia gravis and periventricular nodular heterotopia in neuropsychiatric frame

The coincidence of myasthenia gravis (MG) and psychiatric symptoms/disorders should not be ignored given the high rates of comorbidity and reciprocal influence of conditions on either clinical course or treatment. There exist limited data regarding neurodevelopmental and complex psychiatric conditions in pediatric patients, like a few pieces of evidence on the central nervous system (CNS)-related migratory malformations. To the best of our knowledge, this is the first pediatric case report of a Juvenile MG (JMG) with thymus hyperplasia, a unilateral periventricular nodular heterotrophy (PNH) at the lateral ventricle quite closed to basal ganglia, and severe psychiatric comorbidity complex including affective and neurodevelopmental disorders such as major depression, anxiety, and tic disorders, as well as a background of ADHD and learning disabilities. This female adolescent with JMG, who was followed closely for 3 years with a multidisciplinary treatment approach, may contribute to the literature as a beneficial example for guiding the further examination and management of JMG with severe, complex psychiatric comorbidities, and for demonstrating the positive effects of intravenous immunoglobulin treatment and thymectomy along with proper psychotropic use on both psychiatric and neurological course, as well as for providing insights to clinicians about the presence of possibly associated CNS-malformations.