{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:15:51Z","timestamp":1791825351398,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Myasthenia gravis (MG) is an autoimmune disease presenting typically at an earlier age in females compared to males. However, whether sex affects the diagnostic delay and clinical course of MG has not been extensively explored in systematic cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective single\u2010center cohort study on 251 thymectomized MG patients, including 124 males and 127 females. Mean follow\u2010up was 10.7 (\u00b19.1) years post\u2010thymectomy. We analyzed factors associated with longer diagnostic delay and the type of first\u2010onset symptoms (ocular vs. generalized). For 195 patients with nonthymomatous generalized MG (gMG) pre\u2010thymectomy, we estimated the effect of diagnostic delay, symptoms at onset, and sex on reaching complete stable remission (CSR) or minimal need for medication (MNM) during postoperative follow\u2010up. We also assessed their effect on the overall need for in\u2010hospital treatments, immunosuppressant use, and pyridostigmine dose at the last follow\u2010up visit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Generalized symptoms at onset were more frequent for females than for males (<jats:italic>n<\/jats:italic>\u2009=\u200990, 70.9% vs. <jats:italic>n<\/jats:italic>\u2009=\u200965, 52.4%, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Diagnostic delay was significantly longer in females (6.0\u2009months [0\u2013117.5] vs. 3.2\u2009months in males [0.1\u201384.0]; <jats:italic>p<\/jats:italic>\u2009=\u20090.012). First\u2010onset symptoms and diagnostic delay did not affect the post\u2010thymectomy prognosis of gMG. However, females achieved CSR (17.1% vs. 4.5%; <jats:italic>p<\/jats:italic>\u2009=\u20090.006) and MNM (30.8% vs. 16.9%; <jats:italic>p<\/jats:italic>\u2009=\u20090.029) more frequently and required fewer in\u2010hospital treatments (40.6% vs. 55.2%; <jats:italic>p<\/jats:italic>\u2009=\u20090.010) and immunosuppressants (29.2% vs. 61.7%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) than males.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We report sex\u2010related differences in symptoms at MG onset, length of diagnostic delay, and prognosis, the origins of which should be further studied.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70114","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T13:39:51Z","timestamp":1746452391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Differences Between Females and Males in the Diagnostic Delay and Clinical Course of Thymectomised Myasthenia Gravis"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3959-6257","authenticated-orcid":false,"given":"Chris","family":"Myllynen","sequence":"first","affiliation":[{"name":"Department of Neurosciences University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anni","family":"Tuulasvaara","sequence":"additional","affiliation":[{"name":"Department of Neurosciences University of Helsinki  Helsinki Finland"},{"name":"Department of Neurology Brain Center, Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sari","family":"Atula","sequence":"additional","affiliation":[{"name":"Department of Neurosciences University of Helsinki  Helsinki Finland"},{"name":"Department of Neurology Brain Center, Helsinki University Hospital  Helsinki 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