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Identifying Red Flags in Myasthenia Gravis Diagnosis, Reassessment, and Myasthenic Crisis: An Italian Delphi-Based Position Paper.

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Title: Identifying Red Flags in Myasthenia Gravis Diagnosis, Reassessment, and Myasthenic Crisis: An Italian Delphi-Based Position Paper.
Authors: Habetswallner, Francesco (AUTHOR), Bello, Luca (AUTHOR), Biasini, Fiammetta (AUTHOR), De Martino, Bernardo Maria (AUTHOR), Vanoli, Fiammetta (AUTHOR), Alboini, Paolo E. (AUTHOR), Antonini, Giovanni (AUTHOR), Antozzi, Carlo (AUTHOR), Damato, Valentina (AUTHOR), Di Stefano, Vincenzo (AUTHOR), Evoli, Amelia (AUTHOR), Gastaldi, Matteo (AUTHOR), Iorio, Raffaele (AUTHOR), Maestri, Michelangelo (AUTHOR), Mantegazza, Renato (AUTHOR), Massa, Roberto (AUTHOR), Rinaldi, Rita (AUTHOR), Saccà, Francesco (AUTHOR), Rodolico, Carmelo (AUTHOR), Fee, Dominic B. (AUTHOR)
Source: Acta Neurologica Scandinavica. 1/9/2026, Vol. 2025, p1-10. 10p.
Subjects: Myasthenia gravis, Diagnosis, Medical practice, Warnings, Delphi method, Neuromuscular transmission, Medical audit
Geographic Terms: Italy
Abstract: Background and Purpose: Myasthenia gravis (MG) is a complex autoimmune disorder affecting neuromuscular transmission, often leading to diagnostic and therapeutic challenges. Timely identification of "red flags" in diagnosis, therapeutic reassessment, and myasthenic crisis is crucial to optimizing patient outcomes. This Delphi-based consensus is aimed at synthesizing expert recommendations for improving clinical practice in Italy. Methods: A scientific board of 19 MG specialists and an extended panel of 47 neuromuscular experts participated in a structured Delphi methodology. Over an 11-month period, consensus was developed across four areas: diagnostic red flags, confirmatory instrumental examinations, therapeutic reassessment, and the continuum from exacerbation to impending myasthenic crisis or to crisis. The threshold for achieving consensus was set at ≥'; 75% agreement. Results: Globally, 68 statements reached consensus. Key findings include the identification of "red flags" for suspecting MG, with fluctuating and fatigable muscle weakness serving as primary diagnostic indicators, often involving ocular, bulbar, and respiratory muscles. Instrumental tests, such as repetitive nerve stimulation and antibody assays, were deemed essential for diagnostic confirmation. Therapeutic reassessment in MG is warranted for unsatisfactory symptom control, clinically significant adverse events, new or worsening comorbidities, planning pregnancy, or neoplastic disease. Persistent fluctuations, exacerbations, or triggers like infections should prompt adjustments, aiming to optimize treatment while minimizing risks. High-risk factors and triggers for myasthenic crises, including thymoma and infections, were identified, with arterial blood gas analysis highlighted as critical for crisis management. Conclusions: This consensus provides actionable recommendations to enhance the identification and management of MG, addressing diagnostic delays, therapy optimization, and crisis prevention. These findings aim to guide clinical practice and foster a systematic approach to managing this heterogeneous disorder. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Identifying Red Flags in Myasthenia Gravis Diagnosis, Reassessment, and Myasthenic Crisis: An Italian Delphi-Based Position Paper.
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  Data: <searchLink fieldCode="JN" term="%22Acta+Neurologica+Scandinavica%22">Acta Neurologica Scandinavica</searchLink>. 1/9/2026, Vol. 2025, p1-10. 10p.
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  Data: Background and Purpose: Myasthenia gravis (MG) is a complex autoimmune disorder affecting neuromuscular transmission, often leading to diagnostic and therapeutic challenges. Timely identification of "red flags" in diagnosis, therapeutic reassessment, and myasthenic crisis is crucial to optimizing patient outcomes. This Delphi-based consensus is aimed at synthesizing expert recommendations for improving clinical practice in Italy. Methods: A scientific board of 19 MG specialists and an extended panel of 47 neuromuscular experts participated in a structured Delphi methodology. Over an 11-month period, consensus was developed across four areas: diagnostic red flags, confirmatory instrumental examinations, therapeutic reassessment, and the continuum from exacerbation to impending myasthenic crisis or to crisis. The threshold for achieving consensus was set at &#8805'; 75% agreement. Results: Globally, 68 statements reached consensus. Key findings include the identification of "red flags" for suspecting MG, with fluctuating and fatigable muscle weakness serving as primary diagnostic indicators, often involving ocular, bulbar, and respiratory muscles. Instrumental tests, such as repetitive nerve stimulation and antibody assays, were deemed essential for diagnostic confirmation. Therapeutic reassessment in MG is warranted for unsatisfactory symptom control, clinically significant adverse events, new or worsening comorbidities, planning pregnancy, or neoplastic disease. Persistent fluctuations, exacerbations, or triggers like infections should prompt adjustments, aiming to optimize treatment while minimizing risks. High-risk factors and triggers for myasthenic crises, including thymoma and infections, were identified, with arterial blood gas analysis highlighted as critical for crisis management. Conclusions: This consensus provides actionable recommendations to enhance the identification and management of MG, addressing diagnostic delays, therapy optimization, and crisis prevention. These findings aim to guide clinical practice and foster a systematic approach to managing this heterogeneous disorder. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=190813521
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