{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T22:13:58Z","timestamp":1785276838639,"version":"3.55.0"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005339","name":"American Academy of Neurology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005339","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fixed cell\u2010based assays (CBAs) to detect acetylcholine receptor and muscle\u2010specific tyrosine kinase antibodies (anti\u2010AChR\/MuSK) are now available, but evaluations of their diagnostic performance in clinical practice are lacking. We examined the positive predictive value (PPV) of anti\u2010AChR\/MuSK fixed CBA for myasthenia gravis (MG), following the implementation of this assay as first\u2010line testing at our centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified all patients at our centre with positive anti\u2010AChR\/MuSK fixed CBA results between November 2021 and July 2024. Clinical information was reviewed to classify patients as having true positive or false positive antibody results. Patients with a clinical presentation compatible with MG and no more likely alternative diagnosis were classified as true positives, whereas all others were classified as false positives. Test PPV was calculated as the proportion of positives that were classified as true positives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 770 patients who underwent anti\u2010AChR\/MuSK fixed CBA testing, 109 (14%) had positive antibody results (Anti\u2010AChR, 105; Anti\u2010MuSK, 4). Among them, one patient with anti\u2010AChR positivity was classified as a false positive (suspected thymic hyperplasia without neurologic symptoms). The remaining 108 patients were classified as true positives, resulting in a calculated PPV of 99%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found that anti\u2010AChR\/MuSK fixed CBA had excellent PPV for MG. Anti\u2010AChR positivity in one asymptomatic patient with suspected thymic hyperplasia was classified as a false positive result, although the possibility that it represents a true marker of thymic pathology in a patient who may later develop MG is challenging to exclude. The high PPV reported herein supports the use of anti\u2010AChR\/MuSK fixed CBA as first\u2010line testing for suspected MG.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70123","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T05:58:19Z","timestamp":1743055099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Testing for Acetylcholine Receptor and Muscle\u2010Specific Tyrosine Kinase Antibodies by Fixed Cell\u2010Based Assay in Clinical Practice: Positive Predictive Value for Myasthenia Gravis"],"prefix":"10.1111","volume":"32","author":[{"given":"Cathy Meng Fei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Clinical Neurological Sciences Western University, London Health Sciences Centre  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Nicolle","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences Western University, London Health Sciences Centre  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamala","family":"Sangam","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences Western University, London Health Sciences Centre  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liju","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Western University, London Health Sciences Centre  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4860-0470","authenticated-orcid":false,"given":"Adrian","family":"Budhram","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurological Sciences Western University, London Health Sciences Centre  London Ontario Canada"},{"name":"Department of Pathology and Laboratory Medicine Western University, London Health Sciences Centre  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.596981"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737159.2021.1927715"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2015.0203"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2021.120084"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-329284"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200038"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100846"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16435"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2024.110826"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007096"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.947630"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1380541"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfab127"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12264-012-1256-0"},{"issue":"6","key":"e_1_2_10_16_1","first-page":"859","article-title":"Neural Antibody Testing for Autoimmune Encephalitis: A Canadian Single\u2010Centre Experience","volume":"48","author":"Budhram A.","year":"2021","journal-title":"Canadian Journal of Neurological Sciences"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:48:28Z","timestamp":1747046908000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.70123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/ene.70123"],"URL":"https:\/\/doi.org\/10.1111\/ene.70123","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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