163: The Clinical Reality of Seronegative Myasthenia Gravis

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In this Mind Moments episode, Sarah Hoffmann, MD, PhD, senior neurologist at Charité – University Medicine Berlin, provides clinical insight into the evolving and often challenging landscape of seronegative generalized myasthenia gravis (gMG). Drawing from both clinical experience and research, Hoffmann discusses how seronegative MG is defined in the absence of detectable antibodies and why it represents a heterogeneous and often underrecognized subgroup of patients. The conversation explores key diagnostic challenges, particularly in patients with limb-predominant symptoms, where differentiation from other neuromuscular or functional disorders can be difficult. Hoffmann also reviews current treatment approaches, noting that while standard therapies mirror antibody-positive MG, access to targeted treatments remains limited. Additional discussion focuses on the barriers to advancing clinical trials in this population, the need for reliable biomarkers to better stratify patients, and the importance of continually reassessing diagnosis in nonresponders to avoid both undertreatment and overtreatment.

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Episode Breakdown:

• 1:15 – Defining seronegative MG and estimating prevalence within overall patient population
• 2:15 – Diagnostic challenges and distinguishing seronegative MG from mimics and functional disorders
• 5:35 – Role and limitations of antibody testing, electrophysiology, and pharmacologic response
• 6:50 – Neurology News Network
• 9:05 – Current treatment strategies and variability in access to targeted therapies
• 11:55 – Barriers to clinical trials and need for improved patient stratification methods
• 13:05 – Key unanswered questions including biomarkers and reassessing diagnosis in nonresponders

The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here:

• FDA Accepts Zilganersen New Drug Application for Priority Review in Alexander Disease
• FDA Grants Accelerated Approval to Tividenofusp Alfa for Neurologic Hunter Syndrome
• FDA Approves Higher Strength, More Effective Nusinersen Dose for Spinal Muscular Atrophy

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