{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:30:33Z","timestamp":1785522633463,"version":"3.56.0"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005187","name":"University of Athens","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005187","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurol Belg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A 22-year-old female suffering from MuSK-myasthenia gravis presented with fatigable eyelid ptosis, fluctuated bulbar symptoms and bilateral eyelid twichings which were greatly reinforced after tight closure of eyes and contraction of orbicularis oculi muscles. The patient never received acetylcholinesterase inhibitor treatment. Persistent twichings, irrespectively of clinical status, were signs of cholinergic hyperactivity. MuSK antibodies disrupt MuSK-collagen Q interaction with resultant deficient binding of acetylcholinesterase at synaptic cleft and impaired breakdown of acetylcholine. In myasthenia gravis, clinical signs of cholinergic hyperactivity may point to seropositivity of MuSK antibodies with therapeutic implications in clinical practice.<\/jats:p>","DOI":"10.1007\/s13760-025-02811-1","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T21:14:33Z","timestamp":1750194873000},"page":"893-894","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Eyelid twitching in MuSK-myasthenia gravis"],"prefix":"10.1007","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4652-3582","authenticated-orcid":false,"given":"Vasiliki","family":"Zouvelou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Tzavella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zambelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"2811_CR1","doi-asserted-by":"publisher","first-page":"20783","DOI":"10.1073\/pnas.1313944110","volume":"110","author":"MG Huijbers","year":"2013","unstructured":"Huijbers MG, Zhang W, Klooster R et al (2013) MuSK IgG4 autoantibodies cause myasthenia Gravis by inhibiting binding between musk and LRP4. Proc Natl Acad Sci USA 110:20783\u201320788. https:\/\/doi.org\/10.1073\/pnas.1313944110","journal-title":"Proc Natl Acad Sci USA"},{"key":"2811_CR2","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.cbi.2016.04.019","volume":"259","author":"K Ohno","year":"2016","unstructured":"Ohno K, Otsuka K, Ito M (2016) Roles of collagen Q in musk antibody positive myasthenia Gravis. Chem Biol Interac 259:266\u2013270. https:\/\/doi.org\/10.1016\/j.cbi.2016.04.019","journal-title":"Chem Biol Interac"},{"key":"2811_CR3","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1111\/nyas.13518","volume":"1412","author":"A Evoli","year":"2018","unstructured":"Evoli A, Alboini PE, Damato V et al (2018) Myasthenia Gravis with antibodies to musk: an update. Ann NY Acad Sci 1412:82\u201389. https:\/\/doi.org\/10.1111\/nyas.13518","journal-title":"Ann NY Acad Sci"},{"key":"2811_CR4","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1016\/j.clinph.2021.04.019","volume":"132","author":"A Modoni","year":"2021","unstructured":"Modoni A, Mastrorosa A, Spagni G, Evoli A (2021) Cholinergic hyperactivity in patients with myasthenia Gravis with musk antibodies. A neurophysiological study. Clin Neurophysiol 132:1845\u20131849. https:\/\/doi.org\/10.1016\/j.clinph.2021.04.019","journal-title":"Clin Neurophysiol"},{"key":"2811_CR5","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1002\/mus.20515","volume":"34","author":"AR Punga","year":"2006","unstructured":"Punga AR, Flink R, Askmark H, Stalberg EV (2006) Cholinergic neuromuscular hyperactivity in patients with myasthenia Gravis seropositive for musk antibody. Muscle Nerve 34:111\u2013115. https:\/\/doi.org\/10.1002\/mus.20515","journal-title":"Muscle Nerve"}],"container-title":["Acta Neurologica Belgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02811-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13760-025-02811-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02811-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:17:23Z","timestamp":1785518243000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13760-025-02811-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":5,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2811"],"URL":"https:\/\/doi.org\/10.1007\/s13760-025-02811-1","relation":{},"ISSN":["0300-9009","2240-2993"],"issn-type":[{"value":"0300-9009","type":"print"},{"value":"2240-2993","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"assertion":[{"value":"26 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written consent for publication was obtained from the patient.","order":2,"name":"Ethics","label":"Patient consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}