{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:50:54Z","timestamp":1786704654754,"version":"build-2736575974"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Myasthenia gravis (MG) is an autoimmune disease usually caused by antibodies against the acetylcholine receptor (AChR-Abs), muscle-specific tyrosine kinase (MuSK-Abs), or low-density lipoprotein receptor-related protein 4 (LRP4-Abs). However, there are MG patients who do not have these antibodies and are thus said to have triple-seronegative (triple-SN) MG.<\/jats:p><jats:p>\n          Objective\u2003This study aims to describe the frequency and clinical and epidemiological characteristics of patients with triple-SN MG.<\/jats:p><jats:p>\n          Methods\u2003This was a retrospective cross-sectional study carried out through the analysis of medical records. Descriptive and analytical statistical analysis was performed comparing subgroups of myasthenic patients, classified according to serological profile.<\/jats:p><jats:p>\n          Results\u2003The sample population consisted of 93 MG patients: 85 were positive for antibodies, 80 (86%) with AChR-Abs, 5 (5.4%) with MuSK-Abs, and no MG patients with LRP4-Abs. Eight patients (8.6%) had triple-SN MG; they had a median age at disease onset of 30 years (21-45). Their most common initial symptoms were ptosis, diplopia, and generalized weakness. Most patients presented with mild symptoms at their last visit, reflecting a median MG composite scale score of 4 (0-6), and 75% of patients had an adequate response to treatment.<\/jats:p><jats:p>\n          Conclusion\u2003Our study showed a low frequency of triple-SN MG in Brazilian MG patients. Triple-SN MG was predominant in females, who presented with ptosis, diplopia, and generalized weakness, and most patients had an adequate response to immunosuppressive treatment. There was no significant difference between triple-SN MG and the other subgroups.<\/jats:p>","DOI":"10.1055\/s-0044-1779052","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T01:06:48Z","timestamp":1707181608000},"page":"001-007","source":"Crossref","is-referenced-by-count":8,"title":["Triple-seronegative myasthenia gravis: clinical and epidemiological characteristics"],"prefix":"10.1055","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-0009","authenticated-orcid":false,"given":"Paula Raquel do Vale Pascoal","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."},{"name":"Universidade Federal do Paran\u00e1, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0173-0809","authenticated-orcid":false,"given":"Cl\u00e1udia Suemi Kamoi","family":"Kay","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1673-5074","authenticated-orcid":false,"given":"Renata Dal-Pra","family":"Ducci","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5273-6798","authenticated-orcid":false,"given":"Marco Antonio Takashi","family":"Utiumi","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0778-5376","authenticated-orcid":false,"given":"Otto Jesus Hernandez","family":"Fustes","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1921-1038","authenticated-orcid":false,"given":"Lineu Cesar","family":"Werneck","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."},{"name":"Universidade Federal do Paran\u00e1, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4457-7771","authenticated-orcid":false,"given":"Paulo Jos\u00e9","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-5317","authenticated-orcid":false,"given":"Rosana Herminia","family":"Scola","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Cl\u00ednica M\u00e9dica, Servi\u00e7o de Neurologia, Servi\u00e7o de Doen\u00e7as Neuromusculares, Curitiba PR, Brazil."},{"name":"Universidade Federal do Paran\u00e1, Programa de P\u00f3s-Gradua\u00e7\u00e3o em Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3389\/fimmu.2020.00212","article-title":"Autoantibody Specificities in Myasthenia Gravis; 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