{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:56:34Z","timestamp":1783702594718,"version":"3.55.0"},"reference-count":61,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The association between myasthenia gravis (MG) and depression is intricate and characterized by bidirectional causality. In this regard, MG can be a contributing factor to depression and, conversely, depression may worsen the symptoms of MG. This study aimed to identify any differences in the progression of the disease among patients with MG who were also diagnosed with depression as compared to those without depression. Our hypothesis focused on the theory that patients with more severe MG symptoms may have a higher likelihood of suffering depression at the same time. Materials and Methods: One hundred twenty-two male and female patients (N = 122) aged over 18 with a confirmed diagnosis of autoimmune MG who were admitted to the Neurology II department of Myasthenia Gravis, Clinical Institute Fundeni in Bucharest between January 2019 and December 2020, were included in the study. Patients were assessed at baseline and after six months. The psychiatric assessment of the patients included the Hamilton Depression Rating Scale-17 items (HAM-D), and neurological status was determined with two outcome measures: Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Life (MG-ADL). The patients were divided into two distinct groups as follows: group MG w\/dep, which comprised 49 MG patients diagnosed with depressive disorder who were also currently receiving antidepressant medication, and group MG w\/o dep, which consisted of 73 patients who did not have depression. Results: In our study, 40.16% of the myasthenia gravis (MG) patients exhibited a comorbid diagnosis of depression. Among the MG patients receiving antidepressant treatment, baseline assessments revealed a mean MG-ADL score of 7.73 (SD = 5.05), an average QMG score of 18.40 (SD = 8.61), and a mean Ham-D score of 21.53 (SD = 7.49). After a six-month period, a statistically significant decrease was observed in the MG-ADL (2.92, SD = 1.82), QMG (7.15, SD = 4.46), and Ham-D scores (11.16, SD = 7.49) (p &lt; 0.0001). These results suggest a significant correlation between MG severity and elevated HAM-D depression scores. Regarding the MG treatment in the group with depression, at baseline, the mean dose of oral corticosteroids was 45.10 mg (SD = 16.60). Regarding the treatment with pyridostigmine, patients with depression and undergoing antidepressant treatment remained with an increased need for pyridostigmine, 144.49 mg (SD = 51.84), compared to those in the group without depression, 107.67 mg (SD = 55.64, p &lt; 0.001). Conclusions: Our investigation confirms that the occurrence of depressive symptoms is significantly widespread among individuals diagnosed with MG. Disease severity, along with younger age and higher doses of cortisone, is a significant factor associated with depression in patients with MG. Substantial reductions in MG-ADL and QMG scores were observed within each group after six months, highlighting the effectiveness of MG management. The findings suggest that addressing depressive symptoms in MG patients, in addition to standard MG management, can lead to improved clinical outcomes.<\/jats:p>","DOI":"10.3390\/medicina60010056","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T09:56:27Z","timestamp":1703757387000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Depression: A Contributing Factor to the Clinical Course in Myasthenia Gravis Patients"],"prefix":"10.3390","volume":"60","author":[{"given":"Oana Antonia","family":"Mihalache","sequence":"first","affiliation":[{"name":"Department of Doctoral Studies, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Neurology, \u201cFundeni\u201d Clinical Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crisanda","family":"Vilciu","sequence":"additional","affiliation":[{"name":"Department of Neurology, \u201cFundeni\u201d Clinical Institute, 022328 Bucharest, Romania"},{"name":"Department of Neurology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana-Mihaela","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Neurology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2295-8976","authenticated-orcid":false,"given":"Cristian","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u201cProf. Dr. Alexandru Obregia\u201d Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-4529","authenticated-orcid":false,"given":"Mihnea Costin","family":"Manea","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u201cProf. Dr. Alexandru Obregia\u201d Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2520-5486","authenticated-orcid":false,"given":"Adela Magdalena","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u201cProf. Dr. Alexandru Obregia\u201d Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0741-6274","authenticated-orcid":false,"given":"Constantin Alexandru","family":"Ciobanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020022 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4112-083X","authenticated-orcid":false,"given":"Ovidiu","family":"Popa-Velea","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin","family":"Riga","sequence":"additional","affiliation":[{"name":"Department of Stress Research and Prophylaxis, \u201cProf. Dr. Alexandru Obregia\u201d Clinical Hospital of Psychiatry, 041914 Bucharest, Romania"},{"name":"Romanian Academy of Medical Sciences, 927180 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.ncl.2018.01.002","article-title":"Generalized Myasthenia Gravis","volume":"36","author":"Hehir","year":"2018","journal-title":"Neurol. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ncl.2018.01.011","article-title":"Treatment of Myasthenia Gravis","volume":"36","author":"Farmakidis","year":"2018","journal-title":"Neurol. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1002\/mus.26689","article-title":"Factors associated with acute exacerbations of myasthenia gravis","volume":"60","author":"Gummi","year":"2019","journal-title":"Muscle Nerve"},{"key":"ref_4","doi-asserted-by":"crossref","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":"ref_5","doi-asserted-by":"crossref","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":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhang, B., Shen, C., Bealmear, B., Ragheb, S., Xiong, W.-C., Lewis, R.A., Lisak, R.P., and Mei, L. (2014). Autoantibodies to Agrin in Myasthenia Gravis Patients. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091816"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e975","DOI":"10.1212\/WNL.0000000000012463","article-title":"Characterization of LRP4\/Agrin Antibodies From a Patient With Myasthenia Gravis","volume":"97","author":"Yu","year":"2021","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"290","DOI":"10.21037\/atm-19-363","article-title":"Serological diagnosis of myasthenia gravis and its clinical significance","volume":"11","author":"Li","year":"2023","journal-title":"Ann. Transl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"212","DOI":"10.3389\/fimmu.2020.00212","article-title":"Autoantibody Specificities in Myasthenia Gravis; Implications for Improved Diagnostics and Therapeutics","volume":"11","author":"Lazaridis","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Vinciguerra, C., Bevilacqua, L., Lupica, A., Ginanneschi, F., Piscosquito, G., Rini, N., Rossi, A., Barone, P., Brighina, F., and Di Stefano, V. (2023). Diagnosis and Management of Seronegative Myasthenia Gravis: Lights and Shadows. Brain Sci., 13.","DOI":"10.3390\/brainsci13091286"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2169\/internalmedicine.4957-20","article-title":"Anti-MuSK Positive Myasthenia Gravis with Anti-Lrp4 and Anti-titin Antibodies","volume":"60","author":"Yamashita","year":"2021","journal-title":"Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s10072-019-03746-1","article-title":"Italian recommendations for the diagnosis and treatment of myasthenia gravis","volume":"40","author":"Evoli","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref_13","first-page":"143","article-title":"Diagnostic and clinical classification of autoimmune myasthenia gravis","volume":"48\u201349","author":"Eymard","year":"2014","journal-title":"J. Autoimmun."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1186\/s12967-021-03185-7","article-title":"Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: A systematic review and meta-analysis","volume":"19","author":"Salari","year":"2021","journal-title":"J. Transl. Med."},{"key":"ref_15","first-page":"e1171","article-title":"Clinical and therapeutic features of myasthenia gravis in adults based on age at onset","volume":"94","author":"Segovia","year":"2020","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1590\/0004-282x-anp-2022-s105","article-title":"Myasthenia gravis in clinical practice","volume":"80","author":"Estephan","year":"2022","journal-title":"Arq. Neuro-Psiquiatr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rousseff, R.T. (2021). Diagnosis of Myasthenia Gravis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081736"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"481","DOI":"10.3389\/fpsyt.2019.00481","article-title":"Risk of Depressive Disorders Following Myasthenia Gravis: A Nationwide Population-Based Retrospective Cohort Study","volume":"10","author":"Chu","year":"2019","journal-title":"Front. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e048198","DOI":"10.1136\/bmjopen-2020-048198","article-title":"Patient-reported impact of myasthenia gravis in the real world: Protocol for a digital observational study (MyRealWorld MG)","volume":"11","author":"Claeys","year":"2021","journal-title":"BMJ Open"},{"key":"ref_20","first-page":"8967818","article-title":"Comorbid Depressive and Anxiety Symptoms in a Patient with Myasthenia Gravis","volume":"2020","author":"Cherukupally","year":"2020","journal-title":"Case Rep. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"451","DOI":"10.3389\/fpsyt.2018.00451","article-title":"Depressive Syndromes in Autoimmune Disorders of the Nervous System: Prevalence, Etiology, and Influence","volume":"9","author":"Liu","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_22","first-page":"e9184","article-title":"A Review of Psychiatric Comorbidity in Myasthenia Gravis","volume":"12","author":"Law","year":"2020","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alhaidar, M.K., Abumurad, S., Soliven, B., and Rezania, K. (2022). Current Treatment of Myasthenia Gravis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11061597"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2840","DOI":"10.1002\/brb3.2840","article-title":"Prevalence of depression and anxiety among myasthenia gravis (MG) patients: A systematic review and meta-analysis","volume":"13","author":"JNadali","year":"2022","journal-title":"Brain Behav."},{"key":"ref_26","first-page":"e933296-1","article-title":"Adverse Side Effects Associated with Corticosteroid Therapy: A Study in 39 Patients with Generalized Myasthenia Gravis","volume":"27","author":"Johnson","year":"2021","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1016\/S0140-6736(18)31948-2","article-title":"Depression","volume":"392","author":"Malhi","year":"2018","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S2215-0366(15)00505-2","article-title":"Estimating the true global burden of mental illness","volume":"3","author":"Vigo","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ma, Y., Xiang, Q., Yan, C., Liao, H., and Wang, J. (2021). Relationship between chronic diseases and depression: The mediating effect of pain. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03428-3"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4103\/2229-516X.205809","article-title":"Screening of Patients with Chronic Medical Disorders in the Outpatient Department for Depression Using Handheld Computers as Interface and Patient Health Questionnaire-9 as a Tool","volume":"7","author":"Ingle","year":"2017","journal-title":"Int. J. Appl. Basic Med. Res."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Iacono, S., Di Stefano, V., Costa, V., Schir\u00f2, G., Lupica, A., Maggio, B., Norata, D., Pignolo, A., Brighina, F., and Monastero, R. (2023). Frequency and Correlates of Mild Cognitive Impairment in Myasthenia Gravis. Brain Sci., 13.","DOI":"10.3390\/brainsci13020170"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1080\/00207454.2022.2031183","article-title":"Association between myasthenia gravis and cognitive disorders: A PRISMA-compliant meta-analysis","volume":"133","author":"Zhou","year":"2022","journal-title":"Int. J. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1007\/s00415-020-09767-7","article-title":"Depression in myasthenia gravis: A heterogeneous and intriguing entity","volume":"267","author":"Gavrilov","year":"2020","journal-title":"J. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/ene.14057","article-title":"Chronic stress, depression and personality type in patients with myasthenia gravis","volume":"27","author":"Bogdan","year":"2019","journal-title":"Eur. J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/01.XME.0000481469.56478.b0","article-title":"Myasthenia gravis and psychiatric comorbidities","volume":"23","author":"Salem","year":"2016","journal-title":"Middle East Curr. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1212\/WNL.55.1.16","article-title":"Myasthenia gravis: Recommendations for Clinical Research Standards","volume":"55","author":"Jaretzki","year":"2000","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/j.1749-6632.1998.tb11015.x","article-title":"Reliability Testing of the Quantitative Myasthenia Gravis Score","volume":"841","author":"RBarohn","year":"1998","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1002\/mus.23988","article-title":"Minimal clinically important difference in myasthenia gravis: Outcomes from a randomized trial","volume":"49","author":"Katzberg","year":"2013","journal-title":"Muscle Nerve"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1212\/WNL.52.7.1487","article-title":"Myasthenia gravis activities of daily living profile","volume":"52","author":"Wolfe","year":"1999","journal-title":"Neurology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1002\/mus.27476","article-title":"Utilization of MG-ADL in myasthenia gravis clinical research and care","volume":"65","author":"Muppidi","year":"2022","journal-title":"Muscle Nerve"},{"key":"ref_43","unstructured":"(2023, October 02). R Project Software. Available online: https:\/\/www.R-project.org."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1002\/mus.26719","article-title":"Severity and depression can impact quality of life in patients with myasthenia gravis","volume":"61","author":"Alanazy","year":"2019","journal-title":"Muscle Nerve"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9367453","DOI":"10.1155\/2019\/9367453","article-title":"Prevalence and Associated Factors of Depressive Symptoms in Patients with Myasthenia Gravis: A Cross-Sectional Study of Two Tertiary Hospitals in Riyadh, Saudi Arabia","volume":"2019","author":"Alanazy","year":"2019","journal-title":"Behav. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"492","DOI":"10.4103\/0028-3886.144438","article-title":"Once myasthenic, always myasthenic? Observations on the behavior and prognosis of myasthenia gravis in a cohort of 100 patients","volume":"62","author":"Khadilkar","year":"2014","journal-title":"Neurol. India"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Bogdan, A., Barnett, C., Ali, A., AlQwaifly, M., Abraham, A., Mannan, S., Ng, E., and Bril, V. (2020). Prospective study of stress, depression and personality in myasthenia gravis relapses. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-01802-4"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"295","DOI":"10.4274\/npa.y5611","article-title":"Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastal\u0131k \u015eiddeti ve Tedavi Bi\u00e7imiyle \u0130li\u015fkisi: Kesitsel Bir \u00c7al\u0131\u015fma","volume":"50","author":"Aysal","year":"2013","journal-title":"Noro Psikiyatr. Arsivi"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"96","DOI":"10.26641\/2307-0404.2020.1.200407","article-title":"Features of depression development in myasthenia gravis","volume":"25","author":"Kalbus","year":"2020","journal-title":"Medicni Perspekt. (Med. Perspect.)"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"120268","DOI":"10.1016\/j.jns.2022.120268","article-title":"The humanistic burden of myasthenia gravis: A systematic literature review","volume":"437","author":"Gelinas","year":"2022","journal-title":"J. Neurol. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.jocn.2015.01.022","article-title":"Clinical features and impact of myasthenia gravis disease in Australian patients","volume":"22","author":"Blum","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jns.2019.10.1555","article-title":"Prevalence of depression among sudanese patients with myasthenia gravis","volume":"405","author":"Siddig","year":"2019","journal-title":"J. Neurol. Sci."},{"key":"ref_53","first-page":"712","article-title":"False negatives in the diagnosis of myasthenia gravis","volume":"30","year":"2000","journal-title":"Rev. Neurol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1176\/appi.neuropsych.18120383","article-title":"Management of Insomnia and Anxiety in Myasthenia Gravis","volume":"31","author":"Jordan","year":"2019","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"886625","DOI":"10.3389\/fneur.2022.886625","article-title":"Corticosteroid Treatment-Resistance in Myasthenia Gravis","volume":"13","author":"Kaminski","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e013278","DOI":"10.1136\/bmjopen-2016-013278","article-title":"Social disadvantages associated with myasthenia gravis and its treatment: A multicentre cross-sectional study","volume":"7","author":"Nagane","year":"2017","journal-title":"BMJ Open"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"455","DOI":"10.3109\/00207454.2015.1038712","article-title":"Quality of life in 188 patients with myasthenia gravis in China","volume":"126","author":"Yang","year":"2015","journal-title":"Int. J. Neurosci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12974-022-02448-4","article-title":"Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients","volume":"19","author":"Nelke","year":"2022","journal-title":"J. Neuroinflamm."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"E299","DOI":"10.1212\/WNL.0000000000008688","article-title":"Myasthenic crisis demanding mechanical ventilation","volume":"94","author":"Neumann","year":"2020","journal-title":"Neurology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"175628641983224","DOI":"10.1177\/1756286419832242","article-title":"Understanding the burden of refractory myasthenia gravis","volume":"12","author":"Hagenacker","year":"2019","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/mus.27832","article-title":"Myasthenic crisis","volume":"68","author":"Claytor","year":"2023","journal-title":"Muscle Nerve"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:43:16Z","timestamp":1760132596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/1\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["medicina60010056"],"URL":"https:\/\/doi.org\/10.3390\/medicina60010056","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,28]]}}}