{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:25:33Z","timestamp":1790875533825,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,10,6]],"date-time":"2017-10-06T00:00:00Z","timestamp":1507248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>There are limited data on the natural history of untreated myasthenia gravis (MG) with ocular presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 93 patients from symptom onset who presented to the Birmingham Midlands Eye Centre (BMEC) between January 2004 and July 2015. We used multiple stepwise logistic regression to identify predictive factors of generalization and Kaplan\u2013Meier analysis on time to generalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010six percent of patients developed generalized symptoms during the study period. Median time to generalization was 7 months. Time to generalization was earlier in patients seropositive for acetylcholine receptor (AChR) antibody (median 5 months vs. 21 months, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and bilateral ptosis at onset (<jats:italic>P<\/jats:italic>\u2009=\u20090.015). Multivariate analysis identified AChR seropositivity [hazard ratio (HR) 5.03; 95% confidence interval (CI) 1.48\u201317.14; <jats:italic>P<\/jats:italic>\u2009=\u20090.001] and disease onset\u2009&lt;\u200950 years (HR 3.58; 95% CI 1.18\u201310.90; <jats:italic>P<\/jats:italic>\u2009=\u20090.035) as risk factors for generalization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>As patients were steroid\u2010naive before generalization, our cohort approximated the natural history of the condition. <jats:italic>Muscle Nerve<\/jats:italic> <jats:bold>57<\/jats:bold>: 622\u2013627, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.25971","type":"journal-article","created":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T19:46:11Z","timestamp":1504813571000},"page":"622-627","source":"Crossref","is-referenced-by-count":33,"title":["Ocular presentation of myasthenia gravis: A natural history cohort"],"prefix":"10.1002","volume":"57","author":[{"given":"Sivesh K.","family":"Kamarajah","sequence":"first","affiliation":[{"name":"College of Medical and Dental Sciences University of Birmingham, Vincent Drive Birmingham B15 2TT UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girija","family":"Sadalage","sequence":"additional","affiliation":[{"name":"Division of Neurology University of Nottingham, Nottingham University Hospitals NHS Trust, Queens Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Palmer","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Carley","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Maddison","sequence":"additional","affiliation":[{"name":"Division of Neurology University of Nottingham, Nottingham University Hospitals NHS Trust, Queens Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arulmaran","family":"Sivaguru","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-10-46"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000279334"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-013-0421-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.52.10.1121"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20950"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410140504"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000263481.14289.90"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.21043"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.22306"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00041327-200312000-00002"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2003.08.017"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2008.05.023"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICU.0b013e328310da18"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12057"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24769"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.2.243"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.62.2.156"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0b013e31821c5634"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000327669.75695.38"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2007.07.002"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-14-142"}],"container-title":["Muscle &amp; 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