{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:48:29Z","timestamp":1782258509532,"version":"3.54.5"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":53,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Myasthenia gravis (MG) is an immune-mediated disease with a bimodal incidence: early-onset (&lt; 50 years, predominantly female) and late-onset (&gt; 50 years, predominantly male). Recently, a subgroup with very late-onset (\u2265 65 years) has been described; however, its clinical relevance concerning disease course and prognosis remains uncertain.<\/jats:p>\n                  <jats:p>To evaluate the potential clinical implications of very late presentations of MG.<\/jats:p>\n                  <jats:p>The present is a retrospective cohort study comprising all patients diagnosed with MG currently followed up in the Neuromuscular Disorders Unit of a tertiary center. Clinical and paraclinical parameters including number of hospitalization and current regime were evaluated.<\/jats:p>\n                  <jats:p>A total of 92 patients were included, 51 (55.4%) of whom were female. Concerning the age of onset, 23 (25.6%) patients were classified as very late-onset. In order to better understand the clinical implications of a later onset, we compare the very late-onset subgroup to the late-onset subgroup. Gender distribution and number of patients with minimal manifestation status or better did not statistically differ between these subgroups. Myasthenic crisis and refractoriness were more frequent in the late-onset subgroup compared with very late-onset, but no statistical difference was found (p\u2009=\u20090.221 and p\u2009=\u20090.650 respectively). We did not find statistically significant differences in acetylcholine receptor antibody titers between the groups. Concomitant autoimmune diseases were found in 14 (15.2%) patients, comprising three patients with late-onset and three patients with very late-onset MG.<\/jats:p>\n                  <jats:p>Our study suggests that the recently established subgroup of very late-onset may not be clinically distinct from late-onset MG, as these patients seem to exhibit a similar clinical trajectory.<\/jats:p>","DOI":"10.1055\/s-0046-1824432","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:35:05Z","timestamp":1782257705000},"page":"001-007","source":"Crossref","is-referenced-by-count":0,"title":["Clinical implications of a very late presentation in myasthenia gravis: real world experience in a tertiary center"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2975-9323","authenticated-orcid":false,"given":"Andr\u00e9 Aires","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o, Servi\u00e7o de Neurologia, Porto, Portugal."},{"name":"Universidade do Porto, Faculdade de Medicina, Departamento de Neuroci\u00eancias Cl\u00ednicas e Sa\u00fade Mental, Porto, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-4283","authenticated-orcid":false,"given":"Lu\u00eds","family":"Braz","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o, Servi\u00e7o de Neurologia, Porto, Portugal."},{"name":"Universidade do Porto, Faculdade de Medicina, Departamento de Neuroci\u00eancias Cl\u00ednicas e Sa\u00fade Mental, Porto, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6945-0636","authenticated-orcid":false,"given":"Goreti","family":"Nadais","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o, Servi\u00e7o de Neurologia, Porto, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7823-9410","authenticated-orcid":false,"given":"Fernando","family":"Silveira","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o, Servi\u00e7o de Neurologia, Porto, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9133-4441","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Pinto","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o, Servi\u00e7o de Neurologia, Porto, Portugal."},{"name":"Universidade do Porto, Faculdade de Medicina, Departamento de Neuroci\u00eancias Cl\u00ednicas e Sa\u00fade Mental, Porto, Portugal."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"N E Gilhus","year":"2019","journal-title":"Nature Reviews Disease Primers"},{"issue":"10","key":"ref2","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/s1474-4422(15)00145-3","article-title":"Myasthenia gravis: subgroup classification and therapeutic strategies","volume":"14","author":"N E Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"874680","DOI":"10.1155\/2012\/874680","article-title":"Myasthenia gravis: a review","volume":"2012","author":"A J Trouth","year":"2012","journal-title":"Autoimmune Dis"},{"issue":"11","key":"ref4","doi-asserted-by":"publisher","first-page":"e1171","DOI":"10.1212\/wnl.0000000000008903","article-title":"Clinical and therapeutic features of myasthenia gravis in adults based on age at onset","volume":"94","author":"E Cort\u00e9s-Vicente","year":"2020","journal-title":"Neurology"},{"issue":"04","key":"ref5","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.nmd.2023.02.013","article-title":"Clinical characteristics and prognosis of very late-onset myasthenia gravis in China","volume":"33","author":"Y-L Tang","year":"2023","journal-title":"Neuromuscul Disord"},{"issue":"03","key":"ref6","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/0022-510x(83)90096-5","article-title":"Anti-acetylcholine receptor antibodies in myasthenia gravis. 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Clinical and serological follow-up of individual patients","volume":"58","author":"H J Oosterhuis","year":"1983","journal-title":"J Neurol Sci"},{"issue":"05","key":"ref7","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1212\/wnl.40.5.786","article-title":"The relationship of age to outcome in myasthenia gravis","volume":"40","author":"D H Donaldson","year":"1990","journal-title":"Neurology"},{"issue":"04","key":"ref8","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/wnl.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis: Executive summary","volume":"87","author":"D B Sanders","year":"2016","journal-title":"Neurology"},{"issue":"04","key":"ref9","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.nmd.2023.02.013","article-title":"Clinical characteristics and prognosis of very late-onset myasthenia gravis in China","volume":"33","author":"Y-L Tang","year":"2023","journal-title":"Neuromuscular 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Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1824432.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T23:35:06Z","timestamp":1782257706000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1824432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":21,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["s00461824432"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1824432","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}