Myasthenia Gravis (MG)

MG is an autoimmune disorder characterized by fluctuating muscle weakness due to antibodies targeting the neuromuscular junction (AChR, MuSK, LRP4). Ocular involvement (ptosis, diplopia) often progresses to generalized weakness affecting bulbar, limb, and respiratory muscles.

Symptoms

• Ptosis, diplopia
• Dysarthria, dysphagia, fatigable chewing
• Proximal limb weakness, neck weakness
• Respiratory weakness leading to myasthenic crisis
• Symptoms worsen with activity, improve with rest

Diagnosis

• Clinical history + neurologic exam
• Serology: anti-AChR (85%), anti-MuSK (5–8%), anti-LRP4
• Repetitive nerve stimulation or single-fiber EMG (increased jitter)
• Edrophonium (Tensilon) test rarely used now
• CT/MRI chest to evaluate thymoma
• Rule out drug-induced or congenital myasthenic syndromes

Treatment Strategy

Symptomatic Therapy

• Pyridostigmine enhances neuromuscular transmission
• Adjust dosing for GI side effects

Immunotherapy

• Corticosteroids (prednisone) for generalized MG; slow taper to avoid worsening
• Steroid-sparing agents: azathioprine, mycophenolate, cyclosporine, tacrolimus
• IVIG or plasmapheresis for crisis or rapid improvement
• Thymectomy recommended for thymomatous MG and many AChR-positive patients ≤65 years (improves remission rates)

Targeted Biologics

• Eculizumab/ravulizumab (complement inhibitors) for refractory AChR-positive MG
• Efgartigimod and rozanolixizumab (FcRn inhibitors) reduce pathogenic IgG
• Rituximab effective in MuSK-positive MG

Crisis Management

• ICU care with ventilatory support, plasmapheresis/IVIG, treat triggers (infection, meds)

Lifestyle & Trigger Avoidance

• Avoid medications that worsen MG (aminoglycosides, fluoroquinolones, beta-blockers, magnesium)
• Schedule activities earlier in the day when strength is highest
• Manage stress, infection prevention, vaccinate (pre-eculizumab meningococcal vaccine)

Living with MG

• Track MG-ADL scores, symptom patterns, triggers, medications, infusion schedules
• Plan rest periods, maintain speech/swallow therapy as needed
• Educate family/employers; wear medical ID, keep crisis plan
• Mental health support; fluctuations can be frustrating

Complications

• Myasthenic crisis (respiratory failure)
• Side effects of chronic steroids/immunosuppressants
• Thymoma recurrence (post-surgery surveillance)
• Increased infection risk with biologics

Research & Future Directions

FcRn inhibitors, complement blockers, CAR-Tregs, and antigen-specific tolerance therapies are expanding options.

Experimental & Emerging Treatments

• CAR-Tregs targeting AChR to restore immune tolerance
• Oral tolerogens delivering AChR peptides to retrain immune system
• Novel FcRn inhibitors with subcutaneous weekly dosing
• Digital fatigue tracking linking wearable data to medication titration

Track MG with Diagnoza.care

Balance Activity & Immune Control – Log symptom scores, triggers, pyridostigmine doses, immunotherapy (IVIG, plasmapheresis, biologics), thymectomy status, pulmonary function, vaccinations, and mental health; capture side effects; and let the AI companion flag early signs of crisis or treatment failure.

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Medical Disclaimer: Informational only. Work with your neurologist/myasthenia specialist for tailored immunotherapy, crisis planning, and surgery decisions. Sources: Myasthenia Gravis Foundation of America, American Academy of Neurology, European Academy of Neurology