{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:39:21Z","timestamp":1788485961828,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"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>Background<\/jats:title>\n                    <jats:p>Bulbar involvement in myasthenia gravis (MG) can affect voice and speech; however, task-dependent and potentially subclinical alterations are often underrecognized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study of consecutively enrolled adults with confirmed MG at a single center. Participants completed standardized voice recordings and contemporaneous clinical assessments [Myasthenia Gravis\u2013Activities of Daily Living (MG-ADL) and revised Myasthenia Gravis Quality of Life (rMG-QOL15)]. Tasks included sustained vowels, standardized reading, and spontaneous speech. Acoustic metrics comprised root-mean-square intensity (RMS, dB) and fundamental frequency (F0, Hz).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen patients were enrolled (median age 58\u202fyears; 52.9% female). Median MG-ADL was 6.0 and mean rMG-QOL15 was 16.6, with no significant correlation (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.74). Male participants exhibited significant intensity reductions in connected speech: reading (\u22123.22\u202fdB, IQR\u202f\u2212\u202f5.98 to \u22122.09; pBH\u202f=\u202f0.031;\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.84) and spontaneous speech (\u22125.46\u202fdB, IQR\u202f\u2212\u202f6.11 to \u22124.93; pBH\u202f=\u202f0.031;\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.84). Female participants showed smaller, non-significant changes (\u2264\u202f\u2212\u202f2.2\u202fdB; all pBH\u202f&amp;gt;\u202f0.7). F0 shifts were modest and non-significant after correction. Across the cohort, MG-ADL correlated with both RMS and F0 drops in unadjusted models but not after adjusting for sex. rMG-QOL15 showed no overall association, although females demonstrated a correlation between F0 drop and QOL burden (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Connected-speech intensity decrements may represent a sensitive acoustic marker of load-dependent and potentially subclinical bulbar dysfunction in MG, not fully captured by patient-reported outcomes, with potential sex-related differences requiring further validation in larger cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1756913","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:22:38Z","timestamp":1779164558000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Making the invisible audible: a real-world connected speech study in myasthenia gravis"],"prefix":"10.3389","volume":"17","author":[{"given":"Aurora","family":"Zangh\u00ec","sequence":"first","affiliation":[{"name":"BRAND Center, Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola Sofia","family":"Di Filippo","sequence":"additional","affiliation":[{"name":"BRAND Center, Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Rutigliano","sequence":"additional","affiliation":[{"name":"BRAND Center, Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Avolio","sequence":"additional","affiliation":[{"name":"BRAND Center, Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"BRAND Center, Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Prim"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e20230055","DOI":"10.1590\/2317-1782\/20232023055en","article-title":"Did the speech of patients with myasthenia gravis decline over 4 years?","volume":"36","author":"Ayres","year":"2023","journal-title":"Codas"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"C4","DOI":"10.1111\/j.1525-1497.2006.00343.x","article-title":"Dysphonia as first symptom of late-onset myasthenia gravis","volume":"21","author":"Montero-Odasso","year":"2006","journal-title":"J Gen Intern 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gravis","volume":"95","author":"Mendoza","year":"2020","journal-title":"Neurology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/S1474-4422(23)00080-7","article-title":"Safety and efficacy of zilucoplan in patients with generalised myasthenia gravis (RAISE): a randomised, double-blind, placebo-controlled, phase 3 study","volume":"22","author":"Howard","year":"2023","journal-title":"Lancet Neurol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1016\/S1474-4422(17)30369-1","article-title":"Safety and efficacy of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis (REGAIN): a phase 3, randomised, double-blind, placebo-controlled, multicentre study","volume":"16","author":"Howard","year":"2017","journal-title":"Lancet Neurol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1016\/S1474-4422(21)00159-9","article-title":"Safety, efficacy, and tolerability 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Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1756913\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:22:42Z","timestamp":1779164562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1756913\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":24,"alternative-id":["10.3389\/fneur.2026.1756913"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1756913","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"1756913"}}