{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T01:13:15Z","timestamp":1793841195721,"version":"4.6.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cross-Disciplinary Research Fond of Peking University First Hospital","award":["2023IR07"],"award-info":[{"award-number":["2023IR07"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The co-occurrence of myasthenia gravis (MG) and neuromyelitis optica spectrum disorder (NMOSD) is rare, and their temporal sequence and shared pathogenesis remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present the case of a 43-year-old woman with pre-existing acetylcholine receptor antibody (AChR-Ab) positive ocular MG who developed aquaporin-4 antibody (AQP4-Ab) positive NMOSD. Additionally, we conducted a systematic literature review up to July 2024 to identify similar cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Including the present case, 74 patients were analyzed. The cohort showed a marked female predominance (89.2%). MG onset significantly preceded NMOSD onset in most patients (93.2%), with a younger mean age at onset (28.19 vs. 41.02\u202fyears,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and a mean interval of 12.56\u202fyears. Among tested patients, AChR-Ab was positive in 90.5% and AQP4-Ab in 73.0%. In our case, administration of the complement C5 inhibitor eculizumab led to marked clinical improvement after failure of high-dose steroid therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests a consistent temporal pattern wherein MG predominantly precedes NMOSD, often by years, suggesting a possible shared autoimmune predisposition. The observed response to eculizumab highlights complement pathway inhibition as a potentially effective therapeutic strategy for this complex overlap syndrome, warranting further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1747855","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:22:55Z","timestamp":1770960175000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The temporal sequence of myasthenia gravis and neuromyelitis optica spectrum disorder: a case report and systematic review of 74 patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhenyu","family":"Niu","sequence":"first","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Taihe Hospital, Hubei University of Medicine","place":["Shiyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanqiu","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingru","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjun","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siwei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1038\/s41582-023-00916-w","article-title":"Myasthenia gravis: the changing treatment landscape in the era of molecular therapies","volume":"20","author":"Iorio","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2048","DOI":"10.1007\/s00415-022-11529-6","article-title":"Clinical and 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