2026 American Academy of Neurology Autoimmune Abstract Website

Objective:

Sports performance may offer diagnostic clues and could help in monitoring disease. Traditional MG metrics are subjective; however, swim race times are objective. Incorporating sports performance data into disease monitoring can optimize individualized management and promote better outcomes.

Background:

Juvenile myasthenia gravis(JMG) is a neuromuscular disorder characterized by fluctuating muscle weakness and fatigability. Historically, strenuous exercise was discouraged due to concern about exacerbating symptoms. However, evolving treatment approaches now can allow pediatric patients to resume normal activities, including sports.

Design/Methods:

Recorded race times of an elite teen swimmer before JMG, during progressive JMG prior to diagnosis, following effective treatment to symptom-free status, and then a subsequent flare.

Results:

There was a progressive decline in race times(5-9% slower), beginning in March 2023, which was the earliest indication of dysfunction. As her disease progressed her times slowed more(7-13%). AChR+ JMG was diagnosed October 2023, when she presented with shortness of breath, swallowing difficulties, and the inability to pull herself out of the pool. She started monthly 2g/kg intravenous immunoglobulin (IVIG). A transcervical thymectomy was performed in November 2023 and Rituximab was added in February 2024. In June 2024, 10mg of prednisone was started, which by September resulted in symptom-free status and return to her pre-MG level of swim training. By February 2025, she was swimming personal bests and won all her events and the state level, and was nominated for Oregon Swimmer of the Year. Due to the desire to discontinue prednisone, Zilbrysq was started in July 2025, and she was able to taper completely off steroids. A flare in mid 2025 was first noticed by a slowing of race time to pre-treatment levels.

Conclusions:

Athletic performance can be an important biomarker for disease activity in JMG. In addition, it promotes continued training and exercise. Emerging evidence suggests that physical activity may offer immunomodulatory benefits.