{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:53:42Z","timestamp":1791204822159,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Seronegative myasthenia gravis (SNMG) is characterized by the absence of detectable autoantibodies against known MG targets, despite clinical and electrophysiological evidence of a postsynaptic neuromuscular junction disorder. The aim of this systematic review was to better define clinical features, diagnostic clues and treatment outcome of SNMG patients. We conducted a systematic review following PRISMA guidelines, analyzing studies published from 2001 to August 2024 through MEDLINE, Embase, and Cochrane databases. A total of 31 studies (712 patients) with SNMG diagnoses based on clinical features, electrophysiology, pharmacological testing, or treatment response were included. The cohort was predominantly female (473\/712, 67%) with a mean age at onset of 42\u2009years. Isolated ocular symptoms were present in 281\/500 (56%) patients, with progression to generalized MG in 113\/262 (43%) within 2\u2009years from onset. Regarding diagnostic strategies, some studies combined clinical findings consistent with MG and both electrophysiology and pharmacological testing, while others applied a less stringent diagnostic approach, leading to variability in case definitions. Moreover, only 213\/448 (48%) patients underwent cell\u2010based assays to confirm the seronegative results after antibody screening, raising concerns of misclassification. Immunotherapy was administered to 271\/333 (81%) patients, most commonly corticosteroids combined with immunosuppressants (173\/271, 74%). Despite treatment, only 153\/394 (39%) achieved the minimal manifestations status, and 52\/220 (24%) were classified as refractory. In conclusion, SNMG is a heterogeneous condition with significant diagnostic and therapeutic challenges. Standardized diagnostic criteria, including the use of highly sensitive antibody assays, are needed to improve immunological stratification and optimize therapeutic management.<\/jats:p>","DOI":"10.1002\/mus.70130","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:57:23Z","timestamp":1782968243000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Characteristics and Treatment Management of Seronegative Myasthenia Gravis: A Systematic Review of the Literature"],"prefix":"10.1002","volume":"74","author":[{"given":"Massimiliano Ugo","family":"Verza","sequence":"first","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Schiavolin","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Beretta","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"},{"name":"Department of Neurologia D'Urgenza Azienda Ospedaliero Universitaria Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Cornacchini","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Lotti","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Spagni","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"},{"name":"Department of Neurologia D'Urgenza Azienda Ospedaliero Universitaria Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Damato","sequence":"additional","affiliation":[{"name":"NEUROFARBA Department University of Florence  Florence Italy"},{"name":"Department of Neurologia D'Urgenza Azienda Ospedaliero Universitaria Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2015.1444"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010020\u201010342\u20103"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200038"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13091286"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072\u2010019\u201003746\u20101"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20568"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010019\u201009631\u20103"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1388\u20102457(00)00307\u20102"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/85520"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101618591"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.18502\/cjn.v21i2.10492"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13760\u2010018\u20100943\u20107"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27521"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2011.08.007"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1382320"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25154"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16022"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0929\u20106646(08)60171\u20100"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awg223"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2015.0203"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26985"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp\u20102022\u2010329284"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CND.0b013e318275197c"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752\u20101947\u20108\u20102"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26124"},{"key":"e_1_2_12_28_1","first-page":"351","article-title":"Effects of Rituximab on Prognosis in Myasthenia Gravis: A Single\u2010Center Experience From Turkey","volume":"75","author":"Mehmet G. 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