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This activity is funded by an independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany.

This activity is jointly provided by USF Health and touchIME.
touchIME is an EBAC® accredited provider.

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    Faculty & Disclosures
    Dr Carolina Barnett-Tapia

    University of Toronto, Toronto, ON, Canada

    Dr Carolina Barnett-Tapia is associate professor in the Department of Medicine, Division of Neurology and the Institute of Health Policy, Management and Evaluation, University of Toronto. She is also an active neurologist and clinician-scientist at the University Heath Network, Toronto, Ontario.

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    Dr Carolina Barnett-Tapia obtained her medical degree from Pontificia Universidad Catolica de Chile, and completed her neurology residency at the same institution. She completed a neuromuscular fellowship at the University Health Network, which she combined with a PhD in clinical epidemiology and healthcare research at the University of Toronto. Her main research interest is patient-centered outcomes and patient preference elicitation in patients with neuromuscular disorders and neurofibromatosis.

    Dr Barnett-Tapia developed the Myasthenia Gravis Impairment Index (MGII), a novel, patient-centred measure of disease severity. She has received funding from MGNet and Muscular Dystrophy Canada to study how people with myasthenia gravis make treatment decisions. In 2020, she was the inaugural recipient of the Surinderjit Singh Young Lectureship Award from the American Academy of Neuromuscular and Electrodiagnostic Medicine (AANEM), and in 2023, she received the Myasthenia Gravis Foundation of America (MGFA) medical partner of the year award.

    Dr Carolina Barnett-Tapia discloses: Advisory board or panel fees from Alexion, Argenx, UCB and Janssen. Consultant fees from Argenx, Janssen, Novartis and UCB. Speaker’s bureau fees from Argenx. Other financial or material support from Patent MGII.
    Prof. Nils Erik Gilhus

    University of Bergen and Haukeland University Hospital, Bergen, Norway

    Professor Nils Erik Gilhus is professor (emeritus) in neurology at University of Bergen, Norway since 1987 and a senior researcher at Haukeland University Hospital, Bergen, Norway. He was a senior consultant in neurology from 1986 and is previous dean and head of department.

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    Prof. Gilhus has had a leadership role in national and international scientific and health organizations such as the European Academy of Neurology, the European Federation of Neurological Societies, the European School of Neuroimmunology, the Norwegian Brain Council, the Norwegian Neurological Society, and the Norwegian Medical Association. He has published more than 500 scientific papers, mainly on neuroimmunology and neuroepidemiology, centred on myasthenia gravis. He has supervised more than 30 accomplished PhD students and been a coordinator or partner of six EU research projects.

    Prof. Nils Erik Gilhus discloses: Advisory board or panel fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB. Consultant fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB.
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    Which tool do you use most frequently to assess a suspicion of myasthenia gravis?

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    How can we overcome diagnostic delay in myasthenia gravis?
    How important is serological diagnosis in myasthenia gravis?
    How can we integrate new and emerging agents for the treatment of generalized myasthenia gravis into clinical practice?
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    touchIN CONVERSATION
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    Accelerating myasthenia gravis diagnosis and treatment: Practical strategies and therapeutic advances

    Faculty Podcast Featured
    Useful tips
    • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Spanish.
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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Describe the characteristic clinical and laboratory findings of myasthenia gravis, and the confirmatory diagnostic tests
    • Explain the serological subgroups of myasthenia gravis and their implications for treatment selection
    • Interpret the latest data for newly available therapies in the treatment of generalized myasthenia gravis and their implications for clinical practice
    Overview

    Watch Dr Carolina Barnett-Tapia and Prof. Nils Erik Gilhus discuss the practical considerations for the diagnosis of myasthenia gravis (MG), serological subgroup testing and the implementation of newly available treatments for MG. They will also consider the emerging treatments for generalized MG and the potential impact on the therapeutic landscape.

    This activity is jointly provided by USF Health and touchIME.
    touchIME is an EBAC® accredited provider.

    read more

    Target Audience

    This activity has been designed to meet the educational needs of neurologists, neuromuscular specialists and neurology nurses involved in the management of myasthenia gravis.

    USF Accreditation

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Carolina Barnett-Tapia discloses: Advisory board or panel fees from Alexion, Argenx, UCB and Janssen. Consultant fees from Argenx, Janssen, Novartis and UCB. Speaker’s bureau fees from Argenx. Other financial or material support from Patent MGII.

    Prof. Nils Erik Gilhus discloses: Advisory board or panel fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB. Consultant fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB.

    Content reviewer

    Kathleen Murray, MD has no financial interests/relationships or affiliations in relation to this activity.

    touchIME Medical Contributors

    Judah Issa has no financial interests/relationships or affiliations in relation to this activity.

    Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu 

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 0.75 contact hour may be earned by learners who successfully complete this  continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

    Pharmacists

    USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for (0.75 hour) contact hours (0.75 CEUs).  Universal program number is as follows: 0230-9999-25-012-H01-P

    This activity can be viewed on any web browser such as, but not limited to, Google Chrome, Firefox, Safari, Opera, Microsoft Edge and Internet Explorer.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2026.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    EBAC® Accreditation

    touchIME is an EBAC® accredited provider since 2023.

    This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 54 mins of effective education time.

    The Accreditation Council for Continuing Medical Education (ACCME®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on mutual recognition on substantive equivalency of accreditation systems with EBAC®.

    Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBAC® CE credits to AMA PRA Category 1 CreditsTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other health care professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

    Faculty Disclosure Statement / Conflict of Interest Policy

    In compliance with EBAC® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

    Faculty

    Dr Carolina Barnett-Tapia discloses: Advisory board or panel fees from Alexion, Argenx, UCB and Janssen. Consultant fees from Argenx, Janssen, Novartis and UCB. Speaker’s bureau fees from Argenx. Other financial or material support from Patent MGII.

    Prof. Nils Erik Gilhus discloses: Advisory board or panel fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB. Consultant fees from Alexion, Amgen, Argenx, Denka, Dianthus Therapeutics, Grifols, Huma, Immunovant, Janssen, Johnson & Johnson, Merck, Roche, Takeda, UCB.

    touchIME Medical Contributors

    Judah Issa has no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2027.

    Time to Complete: 54 minutes

    If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
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    Neuromuscular Diseases
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    This activity is funded by:

    An independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany.

    This activity is jointly provided by USF Health and touchIME.
    touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2026.

    EBAC® 

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    touchIME is an EBAC® accredited provider since 2023.

    This content is intended for healthcare professionals outside of the UK only.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2027.

    Claim Credit
    touchIN CONVERSATION
    Accelerating myasthenia gravis diagnosis and treatment: Practical strategies and therapeutic advances
    0.75 CE/CME credit
    Question 1/5
    Which of the following are key red flag symptoms for suspicion of myasthenia gravis?

    Myasthenia gravis is characterized by fatigable muscle weakness in the extraocular muscles, bulbar muscles and limbs. Symptoms often worsen with exertion and improve with rest. Ocular symptoms, including ptosis and double vision, are the most common presenting symptoms of myasthenia gravis.

    Reference

    Dresser L, et al. J Clin Med. 2021;10:2235.

    Question 2/5
    You have a patient who presents with fluctuating muscle weakness and double vision. You suspect this may be myasthenia gravis. Which test has the highest specificity to establish a diagnosis?

    AChR, acetylcholine receptor; RNS, repetitive nerve stimulation; SFEMG, single-fibre electromyography.

    Serological testing is important for confirmation of diagnosis and for therapy decisions in patients with myasthenia gravis.1 The anti-AChR antibody test is very specific and is able to confirm the diagnosis in patients with classical clinical findings.2 Electrophysiological tests, such as the RNS and the SFEMG, are relevant in patients who are seronegative in antibody testing.2

    Abbreviations

    AChR, acetylcholine receptor; RNS, repetitive nerve stimulation; SFEMG, single-fibre electromyography.

    References

    1. Li Y, et al. Ann Transl Med. 2019;11:290.
    2. Beloor Suresh A, Asuncion RMD. Myasthenia Gravis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Available at: www.ncbi.nlm.nih.gov/books/NBK559331/ (accessed 29 April 2025).
    Question 3/5
    You performed serological testing on a patient, the test results came back to show that the patient had a borderline increase in the concentration of AChR antibodies in their blood. Tests for MuSK and LRP4 antibodies came back negative. What would you do next to inform your treatment approach?

    AChR, acetylcholine receptor; LRP4, low-density lipoprotein receptor-related protein 4; MuSK, muscle specific kinase.

    Repeating the testing for AChR, particularly if lower sensitivity testing is used, can help orient the diagnosis in cases of borderline positivity.1 Borderline positive tests may be a result of false-positive tests, this may result in patients being falsely diagnosed with myasthenia gravis and receiving unnecessary treatment with pyridostigmine.2 Retesting patients where there is clinical doubt or using additional testing modalities may help identify cases of false positives or delayed seroconversion.3 It is important to ascertain the patient’s serological subgroup, as the treatment regimen for myasthenia gravis varies according to the associated antibodies.4

    Abbreviation

    AChR, acetylcholine receptor.

    References

    1. Vinciguerra C, et al. Brain Sci. 2023;13:1286.
    2. Zara P, at l. Neurology. 2025;13:e213498.
    3. Rousseff RT. J Clin Med. 2021;10:1736.
    4. Li Y, et al. Ann Transl Med. 2019;11:290.
    Question 4/5
    You are managing a patient with generalized myasthenia gravis who is AChR-antibody-negative and MuSK-antibody-positive and who is still experiencing symptoms after initial therapy, including rituximab. Based on current evidence, which of the following advanced therapies is most appropriate to consider for this patient?

    AChR, acetylcholine receptor; FcRn, neonatal Fc receptor; MuSK, muscle specific kinase.

    Based on the MycarinG phase III trial, the FcRn inhibitor, rozanolixizumab (7 mg/kg or 10 mg/kg) demonstrated a significant and sustained improvement in MG-ADL scores in patients who were AChR-antibody-positive and those who were MuSK-antibody-positive, compared with placebo.1,2 It is currently the only approved FcRn inhibitor in patients who are MuSK-antibody-positive.3,4 As the anti-MuSK antibodies are IgG4, which does not bind complement, there is no role for the use of complement inhibitors in MuSK-antibody-positive myasthenia gravis.5 Thymectomy is recommended in AChR-antibody-positive patients who are eligible and should be performed within 5 years after diagnosis.6

    Abbreviations

    AChR, acetylcholine receptor; FcRn, neonatal Fc receptor; IgG4, immunoglobulin G4; MG-ADL, myasthenia gravis activities of daily living; MuSK, muscle specific kinase.

    References

    1. Bril V, et al. Lancet Neurol. 2023;22:383–94.
    2. Bril V, et al. J Neuromuscul Dis. 2025;12:218–30.
    3. FDA. Rozanolixizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2023/761286s000lbl.pdf (accessed 6 February 2025).
    4. EMA. Rozanolixizumab SmPC. Available at: www.ema.europa.eu/en/documents/product-information/rystiggo-epar-product-information_en.pdf (accessed 26 March 2025).
    5. DeHart-McCoyle M, et al. BMJ Med. 2023;2:e000241.
    6. De Bleecker JL, et al. Acta Neurol Belg. 2024;124:1371–83.
    Question 5/5
    When managing patients with myasthenia gravis, what potential benefits could you consider when deciding to initiate an oral therapy, once available?

    Oral administration is convenient and experiences widespread acceptance from patients.1 Injections and IV infusions are usually administered in a hospital setting, as they require experienced professionals to administer the treatment.2 In addition, IV or subcutaneous administration require needles, syringes and other equipment for administration, resulting in increased healthcare resource utilization compared with oral therapies.2 However, oral administration is associated with variable absorption rates and oral treatments may be contraindicated in some patients.1

    Abbreviation

    IV, intravenous.

    References

    1. Kim J, De Jesus O. Medication routes of administration. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Available at: www.ncbi.nlm.nih.gov/books/NBK568677/ (accessed 2 May 2025).
    2. Cyriac JM, James E. J Pharmacol Pharmacother. 2014;5:83–7.
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    This activity is funded by:

    An independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany.

    This activity is jointly provided by USF Health and touchIME.
    touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2026.

    EBAC® 

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    touchIME is an EBAC® accredited provider since 2023.

    This content is intended for healthcare professionals outside of the UK only.

    Date of original release: 26 June 2025. Date credits expire: 26 June 2027.

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