{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:05:11Z","timestamp":1789610711018,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction\/Aims<\/jats:title>\n                    <jats:p>\n                      Early recognition and treatment are critical in juvenile myasthenia gravis (\n                      <jats:styled-content style=\"fixed-case\">JMG<\/jats:styled-content>\n                      ), yet pediatric\u2010specific evidence remains limited. We aimed to describe treatment patterns, remission rates, and predictors in a Canadian cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of patients under 18\u2009years diagnosed with JMG at The Hospital for Sick Children, Toronto, between 2015 and 2025. Clinical, treatment, and outcome data were collected. Diagnosis was confirmed by antibody positivity or electrophysiology, and outcomes were classified using the Myasthenia Gravis Foundation of America postintervention status (MGFA\u2010PIS). Kaplan\u2013Meier and Cox regression analyses were used to evaluate remission and its predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010six patients were included, 16 with generalized MG (GMG) and 20 with ocular MG (OMG). Mean age at diagnosis was 8.7\u2009years; 50% were female. Acetylcholine receptor\u2010positive, muscle\u2010specific kinase\u2010positive, and seronegative MG accounted for 55.6%, 5.6%, and 38.9% of the cohort, respectively. Repetitive nerve stimulation was abnormal in 82.6% tested. Most patients received pyridostigmine and corticosteroids initially, with additional immunosuppressants in selected cases. Seven received rituximab, and seven underwent thymectomy, with most achieving complete stable remission (CSR). The estimated 3\u2010year remission rate was 36.1%, and 66.7% achieved CSR at last follow\u2010up (median 45.5\u2009months). Older age at onset and early immunosuppression predicted remission, while GMG had a higher rate than OMG (56.2% vs. 20.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Earlier immunosuppression was associated with a higher remission rate, whereas treatment tended to be initiated later and remission was less frequent in OMG. These findings support a timely treatment approach in JMG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mus.70408","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:00:58Z","timestamp":1789610458000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes and Treatment Efficacy in Juvenile Myasthenia Gravis: A Retrospective Review From a Single Center"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-4029","authenticated-orcid":false,"given":"Tanitnun","family":"Paprad","sequence":"first","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Division of Neurology, Department of Pediatrics, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"},{"name":"Department of Pediatrics King Chulalongkorn Memorial Hospital, Thai Red Cross Society  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Nigro","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3441-079X","authenticated-orcid":false,"given":"Zahra","family":"Aleisa","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7925-7586","authenticated-orcid":false,"given":"Freddy","family":"Paiz","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8084-8324","authenticated-orcid":false,"given":"Hernan","family":"Gonorazky","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"1119294","DOI":"10.3389\/fneur.2023.1119294","article-title":"Outcome and Clinical Features in Juvenile Myasthenia Gravis: A Systematic Review and Meta\u2010Analysis","volume":"14","author":"Lin Y.","year":"2023","journal-title":"Frontiers in Neurology"},{"issue":"2","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.pediatrneurol.2012.07.008","article-title":"Management of Juvenile Myasthenia Gravis","volume":"48","author":"Ionita C. M.","year":"2013","journal-title":"Pediatric Neurology"},{"issue":"4","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"e939","DOI":"10.1542\/peds.2013-0814","article-title":"Clinical Characteristics of Pediatric Myasthenia: A Surveillance Study","volume":"132","author":"VanderPluym J.","year":"2013","journal-title":"Pediatrics"},{"key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"743","DOI":"10.3389\/fneur.2020.00743","article-title":"Management of Juvenile Myasthenia Gravis","volume":"11","author":"O'Connell K.","year":"2020","journal-title":"Frontiers in Neurology"},{"issue":"3","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update","volume":"96","author":"Narayanaswami P.","year":"2021","journal-title":"Neurology"},{"issue":"5","key":"e_1_2_14_7_1","first-page":"348","article-title":"Identification and Treatment of Amblyopia","volume":"87","author":"Bradfield Y. S.","year":"2013","journal-title":"American Family Physician"},{"issue":"6","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1212\/CON.0000000000001161","article-title":"Diagnosis and Management of Myasthenia Gravis","volume":"28","author":"Hehir M. K.","year":"2022","journal-title":"Continuum"},{"issue":"1","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/mus.27832","article-title":"Myasthenic Crisis","volume":"68","author":"Claytor B.","year":"2023","journal-title":"Muscle & Nerve"},{"issue":"6","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"3372","DOI":"10.1007\/s00415-022-10986-3","article-title":"Bedside and Laboratory Diagnostic Testing in Myasthenia","volume":"269","author":"Yoganathan K.","year":"2022","journal-title":"Journal of Neurology"},{"issue":"5","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/qjmed\/hcy284","article-title":"Ice Pack Test\u2010An Useful Bedside Test to Diagnose Myasthenia Gravis","volume":"112","author":"Cheo S. W.","year":"2019","journal-title":"QJM"},{"issue":"1","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1212\/WNL.55.1.16","article-title":"Myasthenia Gravis: Recommendations for Clinical Research Standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America","volume":"55","author":"Jaretzki A.","year":"2000","journal-title":"Neurology"},{"issue":"1","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s12883-022-02692-4","article-title":"A Retrospective Longitudinal Cohort Study of the Clinical Burden in Myasthenia Gravis","volume":"22","author":"Harris L.","year":"2022","journal-title":"BMC Neurology"},{"key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1159\/000539577","article-title":"Prevalence, Incidence, and Mortality of Myasthenia Gravis and Myasthenic Syndromes: A Systematic Review","volume":"59","author":"Sciancalepore F.","year":"2025","journal-title":"Neuroepidemiology"},{"issue":"2","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000529583","article-title":"Incidence, Prevalence, Hospitalization Rates, and Treatment Patterns in Myasthenia Gravis: A 10\u2010Year Real\u2010World Data Analysis of German Claims Data","volume":"57","author":"Wartmann H.","year":"2023","journal-title":"Neuroepidemiology"},{"key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s42466-019-0023-3","article-title":"SOP Myasthenic Crisis","volume":"1","author":"Stetefeld H.","year":"2019","journal-title":"Neurology Research and Practice"},{"issue":"2","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1055\/s-0038-1676514","article-title":"Muscle\u2010Specific Kinase Autoimmune Myasthenia Gravis: Report of a Pediatric Case and Literature Review","volume":"50","author":"Ben Younes T.","year":"2019","journal-title":"Neuropediatrics"},{"issue":"8","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/S0960-8966(98)00077-7","article-title":"Juvenile Myasthenia Gravis With Prepubertal Onset","volume":"8","author":"Evoli A.","year":"1998","journal-title":"Neuromuscular Disorders"},{"issue":"5","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/mus.26445","article-title":"Treatment Outcome in Juvenile\u2010Onset Myasthenia Gravis","volume":"59","author":"Jastrzebska A.","year":"2019","journal-title":"Muscle & Nerve"},{"issue":"3","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S0161-6420(99)00138-4","article-title":"The Natural History and Ophthalmic Involvement in Childhood Myasthenia Gravis at the Hospital for Sick Children","volume":"107","author":"Mullaney P.","year":"2000","journal-title":"Ophthalmology"},{"key":"e_1_2_14_21_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ejpn.2022.06.009","article-title":"Rituximab in Juvenile Myasthenia Gravis\u2010An International Cohort Study and Literature Review","volume":"40","author":"Ramdas S.","year":"2022","journal-title":"European Journal of Paediatric Neurology"},{"issue":"6","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1159\/000534336","article-title":"Long\u2010Term Efficacy and Safety of Low\u2010Dose Rituximab in Patients With Refractory Myasthenia Gravis","volume":"86","author":"Ren J.","year":"2023","journal-title":"European Neurology"},{"key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"1275533","DOI":"10.3389\/fneur.2023.1275533","article-title":"Rituximab Treatment in Myasthenia Gravis","volume":"14","author":"Vesperinas\u2010Castro A.","year":"2023","journal-title":"Frontiers in Neurology"},{"issue":"4","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1136\/jnnp-2019-322606","article-title":"Rituximab in AChR Subtype of Myasthenia Gravis: Systematic Review","volume":"91","author":"Di Stefano V.","year":"2020","journal-title":"Journal of Neurology, Neurosurgery, and Psychiatry"},{"issue":"1","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","first-page":"7219","DOI":"10.1038\/s41598-025-90937-w","article-title":"Efficacy and Safety of Rituximab in Anti\u2010MuSK Myasthenia Gravis: A Systematic Review and Meta\u2010Analysis","volume":"15","author":"Chayanopparat S.","year":"2025","journal-title":"Scientific Reports"},{"issue":"2","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/mus.25597","article-title":"Rituximab Treatment of Myasthenia Gravis: A Systematic Review","volume":"56","author":"Tandan R.","year":"2017","journal-title":"Muscle & Nerve"},{"issue":"6","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s00383-017-4086-3","article-title":"The Role of Thymectomy in the Treatment of Juvenile Myasthenia Gravis: A Systematic Review","volume":"33","author":"Madenci A. L.","year":"2017","journal-title":"Pediatric Surgery International"},{"key":"e_1_2_14_28_1","first-page":"35","article-title":"Thymectomy for Juvenile Myasthenia Gravis: A Narrative Review","volume":"8","author":"Carter M.","year":"2024","journal-title":"Media"},{"issue":"2","key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.nmd.2019.11.008","article-title":"Paediatric Myasthenia Gravis: Prognostic Factors for Drug Free Remission","volume":"30","author":"Vecchio D.","year":"2020","journal-title":"Neuromuscular Disorders"},{"key":"e_1_2_14_30_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.pediatrneurol.2018.06.007","article-title":"Juvenile Ocular Myasthenia Gravis: Presentation and Outcome of a Large Cohort","volume":"87","author":"Vanikieti K.","year":"2018","journal-title":"Pediatric Neurology"},{"key":"e_1_2_14_31_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.nmd.2024.07.002","article-title":"Ocular Versus Generalized Myasthenia Gravis: A Continuum Associated With Acetylcholine Receptor Antibody Titers","volume":"43","author":"Axelsen K. H.","year":"2024","journal-title":"Neuromuscular Disorders"},{"issue":"10","key":"e_1_2_14_32_1","doi-asserted-by":"crossref","first-page":"985","DOI":"10.4103\/0301-4738.145987","article-title":"Ocular Myasthenia Gravis: A Review","volume":"62","author":"Nair A. G.","year":"2014","journal-title":"Indian Journal of Ophthalmology"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70408","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.70408","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70408","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:01:04Z","timestamp":1789610464000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.70408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":31,"alternative-id":["10.1002\/mus.70408"],"URL":"https:\/\/doi.org\/10.1002\/mus.70408","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"2025-12-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"mus.70408"}}