Quick Answer
Myasthenia gravis causes fluctuating muscle weakness — worse with activity, better with rest. Treatable with medications and sometimes surgery.
Medically reviewed by Dr. Jitendra Prasad Yadav • NMC 8029 • Kathmandu Neurology Clinic & Cognitive Center
Myasthenia gravis is an autoimmune disorder causing fluctuating muscle weakness — worse with activity, better with rest. It affects muscles controlled by voluntary movement — eye muscles, facial muscles, limb muscles. Treatment is effective with medications, and some patients benefit from thymectomy.
What is myasthenia gravis
Autoimmune: immune system attacks acetylcholine receptors — muscle weakness. Fluctuating weakness: worse with activity, better with rest — characteristic. Fatigability: muscles fatigue with use — improves with rest. Distribution: eye muscles first — ptosis, diplopia. May progress: face, limbs, respiratory muscles — variable. Ocular: only eye muscles — milder form. Generalized: multiple muscle groups — more severe. Crisis: myasthenic crisis — respiratory failure, emergency.
Recognizing myasthenia gravis
Ptosis: drooping eyelids — worse with activity. Diplopia: double vision — eye muscle weakness. Facial weakness: trouble smiling, speaking — facial muscle weakness. Limb weakness: arm/leg weakness — worse with activity. Dysphagia: difficulty swallowing — bulbar weakness. Dyspnea: breathing difficulty — respiratory muscle weakness. Fatigability: symptoms worse later in day — improves with rest.
Diagnosis of myasthenia gravis
Clinical history: fluctuating weakness, fatigability — characteristic. Acetylcholine receptor antibodies: blood test — diagnostic in ~85%. Muscle-specific kinase antibodies: alternative antibody — diagnostic in some. EMG: repetitive nerve stimulation — shows decremental response. Single-fiber EMG: most sensitive test — detects subtle weakness. Edrophonium test: historical — rarely used now. Thymus imaging: CT/MRI — assess thymus for thymoma.
Treatment of myasthenia gravis
Acetylcholinesterase inhibitors: pyridostigmine — first-line symptomatic treatment. Immunosuppression: steroids, azathioprine, mycophenolate — reduce antibodies. Plasmapheresis: plasma exchange — for crisis or severe cases. IVIG: intravenous immunoglobulin — alternative for crisis. Thymectomy: remove thymus — for thymoma or generalized MG. Monoclonal antibodies: eculizumab, efgartigimod — new treatments. Crisis management: ICU care — respiratory support, immunotherapy.
When myasthenia gravis needs specialist care
If you have fluctuating muscle weakness, ptosis, diplopia, or suspected myasthenia gravis — see a neurologist. Myasthenia gravis requires specialist management.
null
When to seek professional evaluation
Myasthenia gravis is discussed at neurology consultation — because proper diagnosis and treatment require specialist care.
This guide is educational and does not replace individual medical advice.
Frequently asked questions
Answers reviewed by Dr. Jitendra Prasad Yadav • MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM • NMC 8029
With modern treatment, most patients live near-normal lifespans. Myasthenic crisis (severe breathing difficulty) is a medical emergency but is manageable with prompt hospital care.
Diagnosis involves clinical assessment of fatigable weakness, antibody testing (AChR, MuSK), repetitive nerve stimulation or single-fiber EMG, and CT chest to evaluate the thymus.
Migraine is a neurological condition; headache is one feature. Associated symptoms and functional impact are important for diagnosis.
Aura refers to visual, sensory, or speech symptoms that precede the headache in some people. Both types are migraine; the presence of aura may influence management discussion.
More: All FAQs → · Ask Dr. Jitendra →
Related articles
Lambert-Eaton Syndrome: The Rare Neuromuscular Junction Disorder
Lambert-Eaton syndrome causes proximal muscle weakness — often associated with cancer. Distinct from myasthenia gravis.
ALS: Amyotrophic Lateral Sclerosis Warning Signs
ALS causes progressive muscle weakness — affecting voluntary movement. Early recognition enables earlier treatment and planning.
Vitamin D Deficiency and Neurological Health: What Nepali Patients Should Know
Vitamin D deficiency is widespread in Nepal — linked to muscle weakness, bone pain, depression and possibly neurological conditions. Testing and treatment explained.
Medical Disclaimer
Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.
References & Review
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-11-10
- International Classification of Headache Disorders, 3rd edition (ICHD-3).
- Harrison's Principles of Internal Medicine — Neurology sections.
- American Academy of Neurology guidelines for selected conditions (where applicable).
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.