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We welcome the proposal of Minimal Symptom Expression (MSE, MG-ADL 0-1) as a patient-centric treatment goal in generalised myasthenia gravis (gMG) [1]. However, its validity as a surrogate for minimal disease activity requires closer scrutiny, particularly regarding how disease duration and patient comprehension affect self-reports. A key mechanism is response shift, the recalibration of internal standards due to long-term adaptation [2].
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