{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:03:38Z","timestamp":1779685418415,"version":"3.53.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"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>This study aimed to identify factors associated with secondary generalization in patients with ocular-onset myasthenia gravis (OoMG) who were positive for anti\u2013acetylcholine receptor (AChR) antibodies. Early identification of patients at higher risk of progression to generalized myasthenia gravis (gMG) is clinically relevant to optimize therapeutic strategies and improve long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study including patients with anti-AChR\u2013positive OoMG recruited from three Italian neurology centers. Demographic, clinical, electrophysiological, and serological data were collected. Univariable and multivariable Cox regression analyses were performed to identify factors associated with disease generalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 85 patients, 40 (47.1%) developed gMG during follow-up. In univariable Cox regression, higher anti-AChR antibody titers (HR 3.37, 95% CI 1.53\u20137.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002) and abnormal repetitive nerve stimulation of facial muscles (HR 2.49, 95% CI 1.16\u20135.34;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.020) were significantly associated with secondary generalization. However, no independent predictors were identified in multivariable analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher anti-AChR antibody titers and abnormal facial repetitive nerve stimulation were associated with an increased risk of secondary generalization in seropositive OoMG. Although these factors did not independently predict generalization in multivariable analysis, their combined assessment may support early clinical risk stratification. Larger prospective studies are warranted to validate these findings and refine prognostic assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1802425","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:36:09Z","timestamp":1779683769000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for disease generalization in acetylcholine receptor antibody-positive ocular myasthenia: a multicenter retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Lorenzo","family":"Verriello","sequence":"first","affiliation":[{"name":"Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Sartor","sequence":"additional","affiliation":[{"name":"Severe Acquired Brain Injury Unit, Department of Rehabilitation Medicine, Institute of Physical and Rehabilitation Medicine, University Hospital of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Bellizzi","sequence":"additional","affiliation":[{"name":"University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Dalla Torre","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Pessa","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Belluzzo","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Bratina","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda","family":"Quagliotto","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara Rosa","family":"Mancinelli","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Rana","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medical, Gorizia-Monfalcone Hospital","place":["Gorizia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvio","family":"Pasquin","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medical, Gorizia-Monfalcone Hospital","place":["Gorizia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Fabris","sequence":"additional","affiliation":[{"name":"Department of Medicine (DMED), Institute of Clinical Pathology, University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Pauletto","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Isola","sequence":"additional","affiliation":[{"name":"Division of Medical Statistic, Department of Medicine (DMED), University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"De Martino","sequence":"additional","affiliation":[{"name":"Division of Medical Statistic, Department of Medicine (DMED), University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Manganotti","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste","place":["Trieste, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariarosaria","family":"Valente","sequence":"additional","affiliation":[{"name":"Clinical Neurology Unit, Department of Head-Neck and Neurosciences, Santa Maria della Misericordia University Hospital","place":["Udine, Italy"]},{"name":"Department of Medicine (DMED), University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.coi.2017.07.006","article-title":"Pathophysiology and immunological profile of myasthenia gravis and its subgroups","volume":"49","author":"Romi","year":"2017","journal-title":"Curr Opin Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1016\/j.autrev.2013.03.010","article-title":"Etiology of myasthenia gravis: innate immunity signature in pathological 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