{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T15:30:12Z","timestamp":1793115012043,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the short-term prognosis of generalized very-late-onset myasthenia gravis (vloMG, symptom onset \u226565\u202fyears) in comparison with early- and late-onset MG (eloMG, &amp;lt;65\u202fyears).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center retrospective cohort study was conducted based on the medical records of patients with laboratory confirmed generalized MG, monitored in the specialized Unit of Neuromuscular Disorders of the University Hospital of Patras. Measures of clinical severity were compared at baseline and over the short term (2-year) follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 42 eligible patients (42.1\u202f\u00b1\u202f13.2\u202fyears, 50% women, 19.5\u202f\u00b1\u202f6.0\u202fmonths follow-up) in the eloMG and 26 (72.4\u202f\u00b1\u202f5.0, 50% women, 13.9\u202f\u00b1\u202f7.9\u202fmonths follow-up) in the vloMG group. In the vloMG group, AchR antibody positivity (89% vs. 57%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.007) and oculo-bulbar symptoms at onset (88% vs. 53%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002) were more common, whereas thymus pathology (0% vs. 40%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and generalized weakness at onset (12% vs. 38%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.018) were less frequent. Intubation within the first month from diagnosis was required only in patients with vloMG (5\/26) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006). Over the follow-up: the unadjusted incidence rate ratio (IRR) of relapses was lower in the vloMG group [IRR\u202f=\u202f0.49, 95% CI\u202f=\u202f(0.26, 0.92),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.026], the unadjusted odds (OR) of being classified as &amp;lt;IIb on the MGFA classification were higher in the vloMG group [OR\u202f=\u202f2.27 95% CI\u202f=\u202f(1.02, 5.05),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.043] and the average unadjusted difference in corticosteroid intake was lower in the vloMG group by approximately 6.9\u202fmg [(\u221210.6, 3.3),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001] in equivalent doses of prednisolone [6.1\u202fmg (\u221210.0, \u22122.2),\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002, according to adjusted estimations].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite its more aggressive onset, vloMG has a more favorable prognosis than eloMG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1641701","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T04:10:33Z","timestamp":1754885433000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["The short-term prognosis of very late onset generalized myasthenia gravis: a single-center retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Ioannis","family":"Liampas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Veltsista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi","family":"Batzikosta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lefteris","family":"Lazarou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zinovia Maria","family":"Kefalopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Chroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"ref1","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":"Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1212\/WNL.0b013e3181ad53c2","article-title":"Seropositive myasthenia gravis: a nationwide epidemiologic study","volume":"73","author":"Heldal","year":"2009","journal-title":"Neurology"},{"key":"ref3","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":"Tang","year":"2023","journal-title":"Neuromuscul Disord"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1111\/j.1468-1331.2010.03089.x","article-title":"Myasthenia gravis requiring pyridostigmine treatment in a national population cohort","volume":"17","author":"Andersen","year":"2010","journal-title":"Eur J Neurol"},{"key":"ref5","volume-title":"Diagnosis and management of juvenile myasthenia gravis","author":"Munot","year":"2019"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e106757","DOI":"10.1371\/journal.pone.0106757","article-title":"Insights into the classification of myasthenia gravis","volume":"9","author":"Akaishi","year":"2014","journal-title":"PLoS One"},{"key":"ref7","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":"Cort\u00e9s-Vicente","year":"2020","journal-title":"Neurology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1136\/jnnp.2008.152637","article-title":"Increasing incidence of elderly onset patients with myasthenia gravis in a local area of Japan","volume":"80","author":"Matsui","year":"2009","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jns.2012.10.028","article-title":"Myasthenia gravis in the elderly","volume":"325","author":"Hellmann","year":"2013","journal-title":"J Neurol Sci"},{"key":"ref10","first-page":"123","article-title":"Late-onset non-thymomatous myasthenia gravis: comparison with early-onset and very late-onset myasthenia gravis","volume":"22","author":"Cho","year":"2017","journal-title":"Neurol Asia"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s42466-020-00091-z","article-title":"Outcome measures and treatment effectiveness in late onset myasthenia gravis","volume":"2","author":"Pasqualin","year":"2020","journal-title":"Neurol Res Pract"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1007\/s10072-024-07920-y","article-title":"Phenotypic patterns and response to immunotherapy in a group of very late onset myasthenia gravis: a single center study","volume":"46","author":"Vakrakou","year":"2025","journal-title":"Neurol Sci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2775","DOI":"10.1007\/s10072-021-05599-z","article-title":"Characteristics of myasthenia gravis in elderly patients: a retrospective study","volume":"43","author":"Li","year":"2022","journal-title":"Neurol Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e28893","DOI":"10.1016\/j.heliyon.2024.e28893","article-title":"Clinical characteristics of late-onset myasthenia gravis","volume":"10","author":"Sun","year":"2024","journal-title":"Heliyon"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"17562864241309793","DOI":"10.1177\/17562864241309793","article-title":"Short-term and long-term prognoses in AChR-ab positive very-late-onset myasthenia gravis patients","volume":"18","author":"Xie","year":"2025","journal-title":"Ther Adv Neurol Disord"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"857402","DOI":"10.3389\/fneur.2022.857402","article-title":"Lack of immunotherapy as the only predictor of secondary generalization in very-late-onset myasthenia gravis with pure ocular onset","volume":"13","author":"Zhao","year":"2022","journal-title":"Front Neurol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"17562864231213240","DOI":"10.1177\/17562864231213240","article-title":"Guideline for the management of myasthenic syndromes","volume":"16","author":"Wiendl","year":"2023","journal-title":"Ther Adv Neurol Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1007\/s10072-023-07082-3","article-title":"Rituximab as a sole steroid-sparing agent in generalized myasthenia gravis: long-term outcomes","volume":"45","author":"Kefalopoulou","year":"2024","journal-title":"Neurol Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"709","DOI":"10.3233\/JAD-220439","article-title":"Antihypertensive medication class and the risk of dementia and cognitive decline in older adults: a secondary analysis of the prospective HELIAD cohort","volume":"89","author":"Liampas","year":"2022","journal-title":"J Alzheimer's Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1002\/mus.27369","article-title":"Clinical profile and impact of comorbidities in patients with very-late-onset myasthenia gravis","volume":"64","author":"Vijayan","year":"2021","journal-title":"Muscle Nerve"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1007\/s13760-020-01290-w","article-title":"Very late onset of myasthenia gravis: case report and brief review of the literature","volume":"120","author":"Oliveira","year":"2020","journal-title":"Acta Neurol Belg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1007\/s00018-012-0970-0","article-title":"Immune aging and autoimmunity","volume":"69","author":"Goronzy","year":"2012","journal-title":"Cell Mol Life Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/j.immuni.2006.05.001","article-title":"Aging of the immune system: how much can the adaptive immune system adapt?","volume":"24","author":"Weng","year":"2006","journal-title":"Immunity"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"251730","DOI":"10.1155\/2012\/251730","article-title":"How does age at onset influence the outcome of autoimmune diseases?","volume":"2012","author":"Amador-Patarroyo","year":"2012","journal-title":"Autoimmune Dis"},{"key":"ref26","volume-title":"How does age at onset influence autoimmune rheumatic diseases?","author":"Amaya-Amaya","year":"2025"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1002\/mus.23964","article-title":"Late-onset myasthenia gravis: a review when incidence in older adults keeps increasing","volume":"48","author":"Alkhawajah","year":"2013","journal-title":"Muscle Nerve"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1111\/j.1532-5415.2000.tb02635.x","article-title":"Clinical characteristics and prognosis of myasthenia gravis in older people","volume":"48","author":"Evoli","year":"2000","journal-title":"J Am Geriatr Soc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1002\/mus.27521","article-title":"Autoantibody profile in myasthenia gravis patients with a refractory phase","volume":"65","author":"Veltsista","year":"2022","journal-title":"Muscle Nerve"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1093\/rheumatology\/keg354","article-title":"Ethnic differences in responses to disease modifying drugs","volume":"42","author":"Helliwell","year":"2003","journal-title":"Rheumatology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"100909","DOI":"10.1016\/j.yfrne.2021.100909","article-title":"Conventional cardiovascular risk factors in transient global amnesia: systematic review and proposition of a novel hypothesis","volume":"61","author":"Liampas","year":"2021","journal-title":"Front Neuroendocrinol"},{"key":"ref32","first-page":"95","article-title":"Muscle weakness in adults: evaluation and differential diagnosis","volume":"101","author":"Larson","year":"2020","journal-title":"Am Fam Physician"}],"updated-by":[{"DOI":"10.3389\/fneur.2025.1716292","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000}}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1641701\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:05:32Z","timestamp":1765807532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1641701\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":32,"alternative-id":["10.3389\/fneur.2025.1641701"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1641701","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]},"article-number":"1641701"}}