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      • Record: found
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      Is Open Access

      International consensus guidance for management of myasthenia gravis : Executive summary

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective:

          To develop formal consensus-based guidance for the management of myasthenia gravis (MG).

          Methods:

          In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness methodology was used to develop consensus guidance statements. Definitions were developed for goals of treatment, minimal manifestations, remission, ocular MG, impending crisis, crisis, and refractory MG. An in-person panel meeting then determined 7 treatment topics to be addressed. Initial guidance statements were developed from literature summaries. Three rounds of anonymous e-mail votes were used to attain consensus on guidance statements modified on the basis of panel input.

          Results:

          Guidance statements were developed for symptomatic and immunosuppressive treatments, IV immunoglobulin and plasma exchange, management of impending and manifest myasthenic crisis, thymectomy, juvenile MG, MG associated with antibodies to muscle-specific tyrosine kinase, and MG in pregnancy.

          Conclusion:

          This is an international formal consensus of MG experts intended to be a guide for clinicians caring for patients with MG worldwide.

          Related collections

          Most cited references3

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          Lifetime course of myasthenia gravis.

          David Grob, Norman Brunner, Tatsuji Namba … (2008)
          Between 1940 and 2000 a total of 1976 patients with myasthenia gravis (MG) were studied. Diagnosis was made by improvement in weakness after anticholinesterase medication. The historical developments in diagnosis and treatment of MG are reviewed. We analyzed the clinical course of MG as influenced by age, gender, thymectomy, thymomectomy, and the presence of antibodies to acetylcholine receptors (AChR). The clinical course of MG was significantly influenced by age and gender, and these need special attention in managing patients. The most severe level of weakness and high mortality occurred during the first 1 to 2 years of the disease, after which many patients experienced improvement. For treating MG patients the usefulness of thymectomy remains to be proven, and novel drugs need to be developed to increase the number as well as normal functioning of the AChRs and other components of the neuromuscular system.
          Article 0 comments Cited 208 times – based on 0 reviews     Review now
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            Myasthenia gravis: Association of British Neurologists' management guidelines.

            Jon Sussman, Maria Farrugia, Paul Maddison … (2015)
            Myasthenia gravis is an autoimmune disease of the neuromuscular junction for which many therapies were developed before the era of evidence based medicine. The basic principles of treatment are well known, however, patients continue to receive suboptimal treatment as a result of which a myasthenia gravis guidelines group was established under the aegis of The Association of British Neurologists. These guidelines attempt to steer a path between evidence-based practice where available, and established best practice where evidence is unavailable. Where there is insufficient evidence or a choice of options, the guidelines invite the clinician to seek the opinion of a myasthenia expert. The guidelines support clinicians not just in using the right treatments in the right order, but in optimising the use of well-known therapeutic agents. Clinical practice can be audited against these guidelines.
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              Myasthenia in pregnancy: best practice guidelines from a U.K. multispecialty working group.

              Fiona Norwood, Mandish Dhanjal, Marguerite Hill … (2014)
              A national U.K. workshop to discuss practical clinical management issues related to pregnancy in women with myasthenia gravis was held in May 2011. The purpose was to develop recommendations to guide general neurologists and obstetricians and facilitate best practice before, during and after pregnancy. The main conclusions were (1) planning should be instituted well in advance of any potential pregnancy to allow time for myasthenic status and drug optimisation; (2) multidisciplinary liaison through the involvement of relevant specialists should occur throughout pregnancy, during delivery and in the neonatal period; (3) provided that their myasthenia is under good control before pregnancy, the majority of women can be reassured that it will remain stable throughout pregnancy and the postpartum months; (4) spontaneous vaginal delivery should be the aim and actively encouraged; (5) those with severe myasthenic weakness need careful, multidisciplinary management with prompt access to specialist advice and facilities; (6) newborn babies born to myasthenic mothers are at risk of transient myasthenic weakness, even if the mother's myasthenia is well-controlled, and should have rapid access to neonatal high-dependency support.
              Article 0 comments Cited 27 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Donald B. Sanders:
                Comment :

                Scientific Advisory Boards:

                1. 1. Medical Advisory Board, Accordant Health Services

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. Royalties for: Single Fiber EMG, Edshagen Publishing House, 2010

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. 1. ArGen-X 2. Jacobus Pharmaceutical Co., Inc 3. Modus Outcomes 4. Momenta Pharmaceuticals, Inc. 5. UCB Celltech

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Gil I. Wolfe:
                Comment :

                Scientific Advisory Boards:

                1. (1)Grifols scientific advisory board (2)Baxalta scientific advisory board (3) Argen X scientific advisory board (4) UCB scientific advisory board

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. (1) Grifols speaker honoraria (2) Baxalta speaker honoraria

                Editorial Boards:

                1. Muscle and Nerve -- Associate Editor

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. (1) Grifols (2) Baxalta

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. CSL Behring

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Michael Benatar:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. Journal Watch Neurology

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. (1) Eli Lilly, (2) Sclerosi Laterale Amiotrofica (AriSLA, (3) Congressionally Directed Medical Research Program (CDMRP) ALS Research Program Integration Panel

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. (1) Food and Drug Administration (R01 FD003710, R01 FD003517) (2) National Institutes of Health (U10 NS077423, U54 NS092091) (3) Department of Defense (DOD11188144)

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. (1) ALS Association

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Amelia Evoli:
                Comment :

                Scientific Advisory Boards:

                1. Served on a scientific advisory board for UCB Biosciences GmbH and for CSL Berhing

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. Scientific award jury member for Grifols

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Nils E. Gilhus:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. Received speaker's honoraria from Octapharma, Baxter, and MerckSerono

                Editorial Boards:

                1. Editorial advisory Board member for Eur J Neurol

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. Torbj?rg Hauge's Legacy

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Isabel Illa:
                Comment :

                Scientific Advisory Boards:

                1. Scientific advisory board Alexion, Novartis, UCB and Argenx

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. Genzyme. Pfizer Travel grant.

                Editorial Boards:

                1. Neurologia, advisory board.

                Patents:

                1. Dysferlin detection in monocytes. Athena Labs.

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. Grifols (commercial entity).

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. (1) FIS (Fondo de Investigaciones Sanitarias), ISCIII, Ministry of Health (Spain), #13/00937, PI, 3 years

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Nancy Kuntz:
                Comment :

                Scientific Advisory Boards:

                1. Dr. Kuntz has served on scientific advisory boards for BioGen Idec, Sarepta Pharmaceuticals, Marathon Pharmaceuticals and Cytokinetics.

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. (1) Cooperative International Neuromuscular Research Group/DOD and NIH, site investigator, 2010-present

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Janice M. Massey:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Arthur Melms:
                Comment :

                Scientific Advisory Boards:

                1. (1) non-profit entity German Myasthenia Gravis Association (2) commercial entity UCB S.A. (3) commercial entity Alexion Pharmaceuticals Inc. (4) commercial entity Moleac Pte Ltd, SINGAPORE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. (1) non-profit entity speaker honoraria from the German Society of Clinical Neurophysiology (2) commercial entity travel funding from Biogen (3) commercial entity travel support from Merz

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. Medical director of a privately owned neurological rehabilitation hospital until June, 2015

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. Professor of Neurology and Neurorehabilitation at the University of Erlangen, Germany (20%), medical director of a privately owned neurological rehabilitation hospital(80%, unitil June 2015), clinical practice (80%, from July 2015)

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. (1) Academic entity University of Erlangen-Nuremberg, Erlangen, Germany

                Research Support, Foundations and Societies:

                1. Ernst Freiberger Foundation, Berlin, Germany

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Hiroyuki Murai:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. (1) BMC Neurology, associate editor, 6 years (2) Clinical and Experimental Neuroimmunology, 4 years

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. (1) Biogen (2) Novartis (3) Bayer (4) Tanabe Mitsubishi (5) Japan Blood Products Organization

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Michael Nicolle:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Jacqueline Palace:
                Comment :

                Scientific Advisory Boards:

                1. UK advisory board participant: 1) Merck Serono 2) Bayer Schering Pharma 3) Biogen Idec 4) Teva Pharmaceutical Industries Ltd. 5) Sanofi-Aventis 6) Alexion

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. Support for attending ECTRIMS Merck Serono Novartis and Biogen idec Talks at scientific meetings (majority have CME) Bayer schering, Biogen Idec, Merk Serono, Medimmune

                Editorial Boards:

                1. NONE

                Patents:

                1. (1) ISIS innovation Limited, a wholly-owned subsidiary of the University of Oxford, has filed a patent application (WO2013/117930 A2) to protect for the use of metabolomics as a method to diagnose and stage disease in multiple sclerosis.

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. In addition to advisory committees, consultant for: Ono Pharmaceuticals Ltd. Chugai Pharma Ltd. CI Consulting Biogen Idec GlaxoSmithKline Alexion

                Speakers' Bureaus:

                1. Teva The CMSC, U.S. Alexion

                Other Activities:

                1. Conference donations: Alexion Chugai EuroImmune MedImmune Genzyme Novartis Biogen Merck Serono MS Society

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. Donations to support local service development and research, none relevant to the current work: Biogen Merck Serono Teva

                Research Support, Government Entities:

                1. Department of Health Risk Sharing Scheme, Clinical Coordinator since 2002 Department of Health funding for a neuromyelitis optica service and a congenital myasthenia service

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. MS Society UK Guthy Jackson Foundation

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                David P. Richman:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. Muscular Dystrophy Association of America (255526), The Myasthenia Gravis Foundation of California and the Myasthenia Gravis Foundation of Illinois.

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Jan Verschuuren:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. Trial support by Biomarin. Role: Subinvestigator in international Duchenne trials on exon skipping. Trial suport from Lilly. Role subinvestigator in Duchenne muscular dystrophy trial

                Research Support, Government Entities:

                1. Participant in the NIH-sponsored thymectomy trial

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. Princes Beatrix Spierfonds, grant for MG research, Prinicpal investigator. Princes Beatrix Spierfonds, grant for neuromuscular epidemiological research, Pricipal investigator Assocation Francaise contre les Myopathies (AFM), support for studies on MuSK myasthenia gravis AFM, support for studies on Duchenne muscular dystrophy European Union, partner in 3 FP7 grants . Two on Duchennen muscular dystrophy and one on myasthenia gravis

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. IBL for MuSK ELISA. All payments to the LUMC. No personnal reimbursements

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Pushpa Narayanaswami:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. 1. AAN: Honorarium for development of neuro PI module 2. Rhode Island Neurological Society: Honorarium for speaking at annual meeting of the society 3. CA Neurological society: Honorarium for speaking at annual meeting of Society

                Editorial Boards:

                1. 1. Neurology. Level of Evidence Review Team 2012-2. Journal of Clinical neuromuscular Disease. Member, Editorial Board 2012-

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. 1. Commercial entity: Blue Cross Blue Shield of Massachusetts, Pharmacy and Therapeutics Committee 2. Commercial entity: Advanced Medical. 3. Commercial entity: Boston Clinical Research Institute.

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. 1. MERZ pharmaceuticals

                Research Support, Government Entities:

                1. Received NIH/NINDS: K24NS060951-01A1, Co-investigator, 2008-2013 Received AHRQ 1R18HS022004-01, Primary Investigator, 2013-2014

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Journal
                Journal ID (nlm-ta): Neurology
                Journal ID (iso-abbrev): Neurology
                Journal ID (hwp): neurology
                Journal ID (publisher-id): neur
                Journal ID (pmc): neurology
                Journal ID (publisher-id): NEUROLOGY
                Title: Neurology
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 0028-3878
                ISSN (Electronic): 1526-632X
                Publication date (Print): 26 July 2016
                Publication date PMC-release: 26 July 2016
                Volume: 87
                Issue: 4
                Pages: 419-425
                Affiliations
                From the Department of Neurology (D.B.S., J.M.M.), Duke University Medical Center, Durham, NC; Department of Neurology (G.I.W.), University at Buffalo School of Medicine and Biomedical Sciences, State University of New York; Department of Neurology (M.B.), University of Miami, Miller School of Medicine, FL; Department of Neurology (A.E.), Catholic University, Rome, Italy; Department of Clinical Medicine (N.E.G.), University of Bergen, Norway; Department of Neurology (I.I.), Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; CIBERER U762 (I.I.), Barcelona, Spain; Departments of Pediatrics and Neurology (N.K.), Northwestern Feinberg School of Medicine, Chicago, IL; Neurologische Klinik (A.M.), Universitätsklinikum Erlangen; Hertie Institute for Clinical Research (A.M.), University of Tübingen, Germany; Department of Neurological Therapeutics (H.M.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Clinical Neurological Sciences (M.N.), Western University, London, Canada; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK; Department of Neurology (D.P.R.), University of California, Davis, CA; Department of Neurology (J.V.), Leiden University Medical Centre, Leiden, the Netherlands; and Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, MA.
                Author notes
                Correspondence to Dr. Sanders: donald.sanders@ 123456duke.edu

                Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was paid by the Myasthenia Gravis Foundation of America.

                [*]

                These authors contributed equally to this work.

                Article
                Publisher ID: NEUROLOGY2015689232
                DOI: 10.1212/WNL.0000000000002790
                PMC ID: 4977114
                PubMed ID: 27358333
                SO-VID: aae0deac-404a-4123-af1f-5652d688a4d1
                Copyright © © 2016 American Academy of Neurology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

                History
                Date received : 25 August 2015
                Date accepted : 19 February 2016
                Categories
                Subject: 179
                Subject: Views & Reviews
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