Myasthenia Gravis: Diagnosis, Clinical Rating, Medications, and Treatment

Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness, including drooping eyelids, weak eye muscles, and double vision. Globally, the majority (28.23%) of MG cases were diagnosed in their mildest form. Studies have shown that women are more often affected than men. The most common age at onset is the second and third decades in women and the seventh and eighth decades in men.

Key takeaways:
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    Symptoms can include drooping eyelids, double vision, and fatigue after activity.
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    Diagnosis can be done through physical symptoms, a blood test or by measuring the electrical activity moving between the brain and the affected muscle.
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    There are several medications and therapeutic techniques available for myasthenia gravis.
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    There are a number of tips that will help you live with the symptoms, including lifestyle changes.


There are various ways to test for myasthenia gravis. A thorough physical examination and review of symptoms should be performed. Included may be a test for coordination, balance, sensation, reflexes, strength, and muscle tone. There is a specific test for a droopy eyelid called the ice bag test, in which your doctor places a bag of ice on the drooping lid and after two minutes, checks for any effect on the eyelid.

A blood test may show unusual antibodies where nerve impulses that make muscles move to block the receptors. Electrodes are attached over the skin of the muscle to be assessed. A small electrical impulse is sent through the electrode attached to the muscle to determine the nerves’ capability.

Another test that determines the electrical activity moving between the brain and the muscle is single-fiber electromyography or EMG. In this test, a small thin needle is inserted into a muscle. This could be in the arms, around the eyes, or in the forehead to see if there might be some disruption of the nerve impulse. An MRI or CT scan can check to see if a tumor is present. Breathing volume can be evaluated by a pulmonary test.

Rating scales

The MG-ADL profile has the patient answer eight questions to show how myasthenia gravis affects them on a day-to-day basis. The questions focus on talking, breathing, chewing, swallowing, brushing teeth or combing hair, getting up out of a chair, double vision, and eye droop. The scale rates from 0 (normal to very mild problem) to 3 (most severe). This scale can also be used in clinical research.


There are several medications and therapeutic techniques available for myasthenia gravis. Some of the medications can be taken alone or together. Treatment will depend how old the patient is, disease progression and how critical the MG is.

Anticholinesterase inhibitors or ACIs help deter the breakdown of chemical signals sent between muscles and nerves, which may aid in muscle improvement.

Corcorticosteroids are designed to suppress creation of antibodies that can cause decreased strength.

Immunosuppressants are also known as ISTs as they stand for immunosuppressive therapies or non-steroidal ISTs, because they are a kind of medicine that does not contain steroids.

Intravenous therapy consists of plasmapheresis in which there is a plasma exchange to ensure that the body’s immune system does not attack itself.

In intravenous immunoglobulin therapy it is used as a need for a fast or rescue treatment for MG until other medication starts to work.

Finally, monoclonal antibodies are given as an infusion that changes the patient’s immune system and destroys damaging antibodies. It is used for quickly worsening or severe MG. Biologic therapy for MG is a treatment made from living things or their components and usually is infusion based.


To ease eye discomfort, try the following:

  • Use audio books or take regular eye breaks. Use a blue light filter or night mode on your smartphone to reduce strain. Check your smartphone’s app store. Carry sunglasses. For optimum protection, they should be rated a category 4 to protect from intense sun glare. Consider lubricating eye drops for dry eyes but discuss this with your eye care physician first.
  • Use accessibility features on your computer, like screen reading programs that will read out loud and a voice-to-text feature which will type while you talk. These will reduce eye fatigue. Search in your web browser or in your smartphone for these programs.
  • Try out adaptive eyewear. If you have double vision, use an eye patch, add masking tape behind the lens on one side of eyeglasses, or visit an eye doctor about a pair of prisms. Wear a cooling eye mask at night to give your eyes a break and improve your quality of sleep.

Improve your health and well-being by doing these:

  • Practice deep breathing. Try three deep belly breaths at a time to de-stress. Exhale longer than you inhale. Avoid childproof medication bottles or use a gripper-type material. Build a list of your medications and always keep it with you. Use a pillbox. Create some wind-down time for yourself.
  • Track and record your symptoms to discuss with your doctor prior to each appointment. Get a referral to an occupational therapist, who can help you make some lifestyle changes and re-organize your home. Locate a source to help you find some MG friendly exercises.

Improve mobility in the bathroom by:

  • Add non-slip rugs to decrease leg fatigue. Make sure they are tacked down; the edges are not curling, and the rugs are well-lit. Install a bidet. Consider color-contrasting walls, floors, and countertops. Switch to an electric toothbrush. Install grab bars around the tub and toilet. Invest in a shower chair.

Tips for getting dressed include:

  • Try a universal cuff to hold and comb or hairbrush and use a stationary hair dryer. Choose clothes in advance so you can save energy during the morning routine. Use a sock aid to don socks and a dressing stick to remove them. Use the dressing stick to pull up pants and push them down and off. Consider a special heavy-duty sock aid for compression stockings. Try a button hook. Consider an adaptive or automatic nail clipper. Consider shoes with Velcro closures or elastic laces. Use a long-handled shoehorn with them.

Kitchen activities can include:

  • Place most often used or heaviest appliances with easy reach. Use gripping material or a damp dishcloth to stabilize a bowl or jar. Buy chopped vegetables. Cook or sauté vegetables to make them softer, easier to eat, and able to release more nutrients. Prepare foods ahead of time when you are feeling most energetic. Make a big batch of an item that you can eat in with smaller meals throughout the week. Avoid sticky foods that can stick in your mouth.

Other tips include:

  • Plan outings ahead of time – look for handicapped access, benches in the shade, and so on. Order groceries in advance to be picked up curbside or delivered. Organize your grocery and errand list. Make use of adaptive tools such as card holders, and cell phone holders to save arm and hand energy. Carve out time each week to do something you enjoy; be with people you love. Keep a journal of your goals and accomplishments. Consider talking with a counselor.

Studies have shown that more women than men get Myasthenia gravis. The neuromuscular condition may present differently from person to person. It’s best to contact your healthcare provider for diagnosis and treatment.


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