Evidence map›Paper›PMID 40447944›Full record

ArticleJournal of neurology2025

Double seronegative myasthenia gravis and mimics: a retrospective cross-sectional study by two tertiary centers in the Southern Italy.

Simona Maccora, Claudia Vinciguerra, Christian Messina, Liliana Bevilacqua, Nicasio Rini, Paolo Barone, Filippo Brighina, Vincenzo Di Stefano

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Simona MaccoraDepartment of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy. simona.maccora@unipa.it.ORCID http://orcid.org/0000-0002-3068-0356
Claudia VinciguerraDepartment of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neurology Unit, University Hospital San Giovanni Di Dio E Ruggi D'Aragona, University of Salerno, 84131, Salerno, Italy.
Christian MessinaDepartment of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy.
Liliana BevilacquaDepartment of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neurology Unit, University Hospital San Giovanni Di Dio E Ruggi D'Aragona, University of Salerno, 84131, Salerno, Italy.
Nicasio RiniDepartment of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy.
Paolo BaroneDepartment of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neurology Unit, University Hospital San Giovanni Di Dio E Ruggi D'Aragona, University of Salerno, 84131, Salerno, Italy.
Filippo BrighinaDepartment of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy.
Vincenzo Di StefanoDepartment of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Via del Vespro 143, 90127, Palermo, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSeronegative myasthenia gravis (MG) accounts for ~ 10% of MG cases, often with mild to moderate symptoms. Diagnosis is frequently delayed or incorrect. Advanced serological, neurophysiological, and objective testing is essential to differentiate MG from similar conditions, avoid misdiagnosis, and ensure appropriate care.

methodsWe retrospectively analyzed 80 patients diagnosed with double-seronegative MG (dSNMG) from 2012 to March 2024 across 2 neuromuscular centers (Palermo and Salerno). Demographic, clinical, neurophysiological, and comorbidity data were reviewed to confirm or exclude MG after follow-up.

resultsMG diagnosis was confirmed in 64% of cases (n = 51), while 36% (n = 29) received alternative diagnoses. Repetitive nerve stimulation (RNS) and single-fiber electromyography (SFEMG) were highly accurate in identifying MG. Among MG mimics, functional disorders were most frequent (45%), followed by oculopharyngeal muscular dystrophy, benign essential blepharospasm, Basedow-Graves ophthalmopathy, and refraction defects. MG mimics had longer diagnostic delays and a higher prevalence of psychiatric disorders. Confirmed MG cases were predominantly female, with a median onset age of 50 years; 67% had mild to moderate disease (MGFA class I-II). These patients required higher pyridostigmine doses and had common comorbidities, including hypertension, cardiovascular, and autoimmune diseases.

conclusionDiagnosing seronegative MG is challenging. In our cohort, neurophysiological testing played a key role in confirming MG, which presented mostly as a mild to moderate form responsive to symptomatic treatment. Notably, 45% of alternative diagnoses were functional disorders.

Indexed as

Myasthenia GravisAdultAgedCross-Sectional StudiesDiagnosis, DifferentialElectromyographyFemaleHumansItalyMaleMiddle AgedRetrospective StudiesTertiary Care CentersYoung AdultDouble-seronegative myasthenia gravisMisdiagnosisMyasthenia gravis mimicsRepetitive nerve stimulationSingle-fiber electromyography

Identifiers

PMID40447944

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.