{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:57:47Z","timestamp":1790866667693,"version":"4.1.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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>High-dose intravenous methylprednisolone pulse therapy (HMP) may provide rapid symptom relief in ocular myasthenia gravis (MG), but the clinical impact of its early use as induction immunotherapy remains unclear. We evaluated whether early HMP was associated with more rapid symptom improvement in patients with persistent ocular MG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective study included 36 patients with ocular MG who received corticosteroid-based immunotherapy and remained classified as having ocular MG throughout 2\u202fyears of follow-up. Patients were categorized according to their initial immunotherapy strategy into an early HMP induction group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f19), which received HMP at oral prednisolone initiation or within 3\u202fweeks thereafter, and an oral corticosteroid (OCS) induction group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f17), which initially received OCS without HMP. Additional HMP during follow-up was permitted. The primary outcome was the longitudinal change in ocular MG Activities of Daily Living (MG-ADL) score over 24\u202fmonths, analyzed using a linear mixed-effects model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline ocular MG-ADL scores were higher in the HMP group (mean \u00b1 standard deviation, 4.842\u202f\u00b1\u202f1.642 vs. 3.353\u202f\u00b1\u202f1.057). The mixed-effects model demonstrated a significant group-by-time interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). At 1\u202fmonth, the least-squares mean ocular MG-ADL score was 0.474 (95% confidence interval [CI], 0.024\u20130.923) in the HMP group and 2.000 (95% CI, 1.525\u20132.475) in the OCS group, with a significant between-group difference after Tukey adjustment (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). From 3\u202fmonths onward, scores remained low in both groups without significant between-group differences. The HMP group achieved minimal symptom expression earlier. Oral prednisolone doses and prednisolone-related adverse events did not differ significantly between groups. Initial worsening occurred in two HMP-treated patients, but neither developed myasthenic crisis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In persistent ocular MG, early HMP as part of induction immunotherapy was associated with faster ocular symptom improvement and earlier achievement of minimal symptom expression than OCS induction alone, while long-term clinical outcomes and oral prednisolone doses were similar. Early HMP may be useful when rapid symptom control is required, although prospective studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1956054","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:25:16Z","timestamp":1790864716000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early high-dose intravenous methylprednisolone is associated with faster symptom improvement in persistent ocular myasthenia gravis: a single-center retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Noritaka","family":"Matsuo","sequence":"first","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genya","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chihiro","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayane","family":"Tamagake","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeko","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Tsukita","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Sendai Medical Center","place":["Sendai, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/cen3.12739","article-title":"The Japanese clinical guidelines 2022 for myasthenia gravis and Lambert\u2013Eaton myasthenic syndrome","volume":"14","author":"Murai","year":"2023","journal-title":"Clin Exp Neuroimmunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1002\/mus.24769","article-title":"Efficacy of prednisone for the treatment of ocular myasthenia (EPITOME): a randomized, controlled 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