Urinary dysfunction in myasthenia gravis: a cross-sectional case-control study

Q: What urinary outcomes were evaluated in the study of myasthenia gravis?

Urinary incontinence (UI) was assessed using the ICIQ-UI Short Form, and overactive bladder (OAB) symptoms were assessed using the Overactive Bladder Symptom Score.

Q: How were MG severity and patient subgroups defined?

MG severity was measured with the MG-ADL scale. Patients were categorized by onset timing into early-onset (EOMG), late-onset (LOMG), and very late-onset (VLOMG) subgroups.

Sep 29, 2026

Uploaded by Asher

The study examines urinary dysfunction in myasthenia gravis (MG), focusing on urinary incontinence (UI) and overactive bladder (OAB) symptoms that are less characterized than motor complaints. Eighty-six MG patients and 90 matched inpatient controls complete the ICIQ-UI SF and OABSS, while MG severity is measured with MG-ADL. Logistic regression tests predictors of UI, and Kaplan–Meier analysis evaluates time to first UI symptoms.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Methods

Results

Discussion

Introduction

Myasthenia gravis and urinary dysfunction background

Neurogenic mechanisms and micturition coordination

Potential MG-linked contributors

Prior evidence and study rationale

Neurological Sciences (2026) 47:91 [https://doi.org/10.1007/s10072-025-08588-8](https://doi.org/10.1007/s10072-025-08588-8) ORIGINAL ARTICLE Urinary dysfunction in myasthenia Gravis: a cross-sectional casecontrol study Kamel Shihada1,2 · Alon Gorenshtein1,2 · Gil I. Wolfe3 · Shahar Shelly1,4,5 Received: 7 October 2025 / Accepted: 5 December 2026 / Published online: 3 January 2026 © The Author(s) 2025 Abstract Introduction Myasthenia gravis (MG) is a disorder of neuromuscular transmission that primarily affects skeletal muscles, leading to cranial, truncal, and limb weakness. While motor symptoms are well documented, the prevalence and clinical significance of urinary dysfunction particularly urinary incontinence (UI) and overactive bladder (OAB) symptoms remain underexplored in MG, with previous reports limited to small cohorts. Methods In this study, 86 MG patients and 90 age-and sex-matched inpatient controls were evaluated. All participants completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF) and the Overactive Bladder Symptom Score (OABSS) . MG severity was assessed using the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale. MG patients were further categorized into early-onset (EOMG), late-onset (LOMG), and very late-onset (VLOMG) subgroups. Logistic regression identified predictors of UI, and Kaplan–Meier analysis was used to evaluate time to first UI symptoms. Results MG patients had significantly higher prevalence of UI symptoms (ICIQ-UI SF ≥ 6 in 52.3% vs. 12.2% in controls; p < 0.001) . LOMG patients exhibited the highest UI prevalence (63.2%) and progressed most rapidly to UI, while EOMG patients had the latest onset. OAB symptoms were also more prominent in MG, marked by higher OABSS and increased urgency. MG-ADL score independently predicted UI (OR 2.38; 95% CI 1.04–5.46; p= 0.041) . Discussion UI and OAB symptoms are more common in MG patients than in controls. MG-ADL score is an independent predictor of UI, and age at disease onset may influence the timing of UI development. Early identification and intervention may improve patient outcomes. Keywords Urinary incontinence · Myasthenia gravis · Overactive bladder · Pyridostigmine · MG-ADL 􀀍 Kamel Shihada[sh2000.kamel@gmail.com](sh2000.kamel@gmail.com) 1 Department of Neurology, Rambam Medical Center, Haifa, Israel 2 Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel 3 Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, Buffalo, NY, USA 4 Neuroimmunology Laboratory, Ruth, and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa 3525408, Israel 5 Department of Neurology, Mayo Clinic, Rochester, MN, USA Introduction Myasthenia gravis (MG) is an immune-mediated chronic neuromuscular junction (NMJ) disorder, characterized by fatigable weakness of skeletal muscles due to autoantibodymediated attack on the postsynaptic membrane [1]. Approximately 80% of patients exhibit elevated levels of antibodies targeting the nicotinic acetylcholine receptor (AChR), impairing synaptic transmission [2]. Muscle-specific kinase (MuSK) antibodies are present in 5%–8% of all MG patients, and interfere with the clustering of AChR at NMJs [3]. Clinically, MG presents with varied constellations of ocular symptoms (e.g., ptosis, diplopia), bulbar involvement (e.g., dysphagia, dysarthria), trunk and limb weakness and dyspnea [4] . Urinary incontinence (UI) is a known clinical manifestation of various neurologic diseases such as multiple sclerosis (MS), Parkinson’s disease (PD), stroke, and spina bifida, often arising due to neurogenic detrusor overactivity leading to overactive bladder (OAB) symptoms [5, 6] . In MG, urinary dysfunction has been reported, but only in small cohorts, and its significance remains uncertain. Pathophysiological mechanisms potentially linking MG to urinary dysfunction are limit

FAQs

What urinary outcomes were evaluated in the study of myasthenia gravis?

Urinary incontinence (UI) was assessed using the ICIQ-UI Short Form, and overactive bladder (OAB) symptoms were assessed using the Overactive Bladder Symptom Score.

How were MG severity and patient subgroups defined?

MG severity was measured with the MG-ADL scale. Patients were categorized by onset timing into early-onset (EOMG), late-onset (LOMG), and very late-onset (VLOMG) subgroups.

What analyses were used to identify predictors and timing of UI symptoms?

Logistic regression identified predictors of UI, and Kaplan–Meier analysis was used to evaluate time to first UI symptoms.

Sep 29, 2026

Uploaded by Asher