Myasthenia gravis - Diagnosis and treatment (2023)


Your doctor will review your symptoms and your medical history and conduct a physical examination. Your doctor might use several tests, including:

Neurological examination

Your doctor may check your neurological health by testing:

  • Reflexes
  • Muscle strength
  • Muscle tone
  • Senses of touch and sight
  • Coordination
  • Balance

Tests to help confirm a diagnosis of myasthenia gravis might include:

Ice pack test

If you have a droopy eyelid, your doctor might place a bag filled with ice on your eyelid. After two minutes, your doctor removes the bag and analyzes your droopy eyelid for signs of improvement.

Blood analysis

A blood test might reveal the presence of abnormal antibodies that disrupt the receptor sites where nerve impulses signal your muscles to move.

Repetitive nerve stimulation

In this nerve conduction study, doctors attach electrodes to your skin over the muscles to be tested. Doctors send small pulses of electricity through the electrodes to measure the nerve's ability to send a signal to your muscle.

To diagnose myasthenia gravis, doctors will test the nerve repeatedly to see if its ability to send signals worsens with fatigue.

Single-fiber electromyography (EMG)

This test measures the electrical activity traveling between your brain and your muscle. It involves inserting a fine wire electrode through your skin and into a muscle to test a single muscle fiber.

(Video) Myasthenia Gravis | Pathophysiology, Signs & Symptoms, Diagnosis, Treatment


Your doctor might order a CT scan or an MRI to check if there's a tumor or other abnormality in your thymus.

Pulmonary function tests

These tests evaluate whether your condition is affecting your breathing.

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  • CT scan
  • Electromyography (EMG)
  • MRI


Various treatments, alone or in combination, can relieve symptoms of myasthenia gravis. Your treatment will depend on your age, how severe your disease is and how fast it's progressing.


  • Cholinesterase inhibitors. Medications such as pyridostigmine (Mestinon, Regonal) enhance communication between nerves and muscles. These medications aren't a cure, but they can improve muscle contraction and muscle strength in some people.

    (Video) Myasthenia gravis - causes, symptoms, treatment, pathology

    Possible side effects include gastrointestinal upset, diarrhea, nausea, and excessive salivation and sweating.

  • Corticosteroids. Corticosteroids such as prednisone (Rayos) inhibit the immune system, limiting antibody production. Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes and increased risk of some infections.
  • Immunosuppressants. Your doctor might also prescribe other medications that alter your immune system, such as azathioprine (Azasan, Imuran), mycophenolate mofetil (Cellcept), cyclosporine (Sandimmune, Gengraf, others), methotrexate (Trexall) or tacrolimus (Astrograf XL, Prograf, others). These drugs, which can take months to work, might be used with corticosteroids.

    Side effects of immunosuppressants, such as increased risk of infection and liver or kidney damage, can be serious.

Intravenous therapy

The following therapies are usually used in the short term to treat a sudden worsening of symptoms or before surgery or other therapies.

  • Plasmapheresis (plaz-muh-fuh-REE-sis). This procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that block transmission of signals from your nerve endings to your muscles' receptor sites. However, the good effects usually last only a few weeks, and repeated procedures can lead to difficulty accessing veins for the treatment.

    Risks associated with plasmapheresis include a drop in blood pressure, bleeding, heart rhythm problems or muscle cramps. Some people develop an allergic reaction to the solutions used to replace the plasma.

  • Intravenous immunoglobulin (IVIg). This therapy provides your body with normal antibodies, which alters your immune system response. Benefits are usually seen in less than a week and can last 3 to 6 weeks.

    Side effects, which usually are mild, can include chills, dizziness, headaches and fluid retention.

    (Video) Myasthenia Gravis: Symptoms and Treatment | Ohio State Medical Center

  • Monoclonal antibody. Rituximab (Rituxan) and the more recently approved eculizumab (Soliris) are intravenous medications for myasthenia gravis. These drugs are usually used for people who don't respond to other treatments. They can have serious side effects.


Some people with myasthenia gravis have a tumor in the thymus gland. If you have a tumor, called a thymoma, doctors will surgically remove your thymus gland (thymectomy).

Even if you don't have a tumor in the thymus gland, removing the gland might improve your myasthenia gravis symptoms. However, the benefits of thymectomy can take years to develop.

A thymectomy can be performed as an open surgery or as a minimally invasive surgery. In open surgery, your surgeon splits the central breastbone (sternum) to open your chest and remove your thymus gland.

Minimally invasive surgery to remove the thymus gland uses smaller incisions. It might also involve:

  • Video-assisted thymectomy. In one form of this surgery, surgeons make a small incision in your neck or a few small incisions in the side of your chest. They then use a long, thin camera (video endoscope) and small instruments to see and remove the thymus gland.
  • Robot-assisted thymectomy. In this form of thymectomy, surgeons make several small incisions in the side of your chest and remove the thymus gland using a robotic system, which includes a camera arm and mechanical arms.

These procedures might cause less blood loss, less pain, lower mortality rates and shorter hospital stays compared with open surgery.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

(Video) Clinical Picture: Open your eyes to a cool bedside test for myasthenia gravis

Lifestyle and home remedies

To help you make the most of your energy and cope with the symptoms of myasthenia gravis:

  • Adjust your eating routine. Try to eat when you have good muscle strength. Take your time chewing your food, and take a break between bites of food. You might find it easier to eat small meals several times a day. Also, try eating mainly soft foods and avoid foods that require more chewing, such as raw fruits or vegetables.
  • Use safety precautions at home. Install grab bars or railings in places where you need support, such as next to the bathtub or next to steps. Keep your floors clean, and move area rugs. Outside your home, keep paths, sidewalks and driveways cleared of leaves, snow and other debris that could cause you to stumble.
  • Use electric appliances and power tools. To help you maintain your energy, try using an electric toothbrush, electric can openers and other electrical tools to perform tasks.
  • Wear an eye patch. If you have double vision, an eye patch can help relieve the problem. Try wearing one to write, read or watch television. Periodically switch the eye patch to the other eye to help reduce eyestrain.
  • Plan. If you have chores, shopping or errands to do, plan the activity for when you have the most energy.

Coping and support

Coping with myasthenia gravis can be difficult for you and your loved ones. Stress can worsen your condition, so find ways to relax. Ask for help when you need it.

Learn all you can about your condition, and have your loved ones learn about it as well. You all might benefit from a support group, where you can meet people who understand what you and your family members are going through.

Preparing for your appointment

You're likely to first see your family doctor, who will then refer you to a doctor trained in nervous system conditions (neurologist) for further evaluation.

Here's information to help you get ready for your appointment.

What you can do

Take a friend or family member along to help you absorb the information you're given. Make a list of:

  • Your symptoms and when they began
  • All medications, vitamins or supplements you take, including doses
  • Questions to ask your doctor

For myasthenia gravis, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What tests do I need?
  • What course of action do you recommend?
  • What are the alternatives to the approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

(Video) Myasthenia Gravis in Children and Teenagers

What to expect from your doctor

Be prepared to answer questions your doctor is likely to ask, such as:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

By Mayo Clinic Staff


What is the best way to diagnose myasthenia gravis? ›

The main test for myasthenia gravis is a blood test to look for a type of antibody (produced by the immune system) that stops signals being sent between the nerves and muscles. A high level of these antibodies usually means you have myasthenia gravis.

How is myasthenia gravis diagnosed and treated? ›

Repetitive nerve stimulation

Doctors send small pulses of electricity through the electrodes to measure the nerve's ability to send a signal to your muscle. To diagnose myasthenia gravis, doctors will test the nerve repeatedly to see if its ability to send signals worsens with fatigue.

What is the most common treatment for myasthenia gravis? ›

Pyridostigmine. The first medicine used for myasthenia gravis is usually a tablet called pyridostigmine, which helps electrical signals travel between the nerves and muscles. It can reduce muscle weakness, but the effect only lasts a few hours so you'll need to take it several times a day.

What are the markers for myasthenia gravis? ›

Common symptoms include double vision, drooping eyelids and/or eye closure. Approximately 15% of people with MG have ocular problems only. Ocular symptoms are often the first symptoms of MG, and many people may develop other generalized muscle weakness issues later on.

What are the most common early symptoms of myasthenia gravis? ›

Common symptoms of myasthenia gravis include:
  • droopy eyelids.
  • double vision.
  • difficulty making facial expressions.
  • problems chewing and difficulty swallowing.
  • slurred speech.
  • weak arms, legs or neck.
  • shortness of breath and occasionally serious breathing difficulties.

How does myasthenia gravis start? ›

Myasthenia gravis is caused by an error in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction—the place where nerve cells connect with the muscles they control.

What is the first line treatment for myasthenia gravis? ›

Pyridostigmine is the first line of therapy (see 'Dose and titration' above). If anticholinesterase medications are not sufficient, plasmapheresis or intravenous immune globulin (IVIG) may be used, but the benefits are transient.

How serious is myasthenia gravis? ›

Myasthenia gravis is a treatable disease and most patients will live a relatively normal life with treatment. Treatments for MG focus on improving symptoms. Treatments include: Medications: Cholinesterase inhibitors (anticholinesterase) boost signals between nerves and muscles to improve muscle strength.

What are 3 factors that can make myasthenia gravis worse? ›

Factors that can worsen myasthenia gravis
  • Fatigue.
  • Illness or infection.
  • Surgery.
  • Stress.
  • Some medications — such as beta blockers, quinidine gluconate, quinidine sulfate, quinine (Qualaquin), phenytoin, certain anesthetics and some antibiotics.
  • Pregnancy.
  • Menstrual periods.
Jun 22, 2021

What foods should you avoid if you have myasthenia gravis? ›

Choose chicken or fish instead of tougher meats. Avoid dry crumbly food such as crackers, rice, cookies, nuts, chips or popcorn. Avoid bread products such as sandwiches, bagels and muffins. Focus on the swallow.

What are the stages of myasthenia gravis? ›

  • Class I: Involves any ocular muscle weakness, including weakness of eye closure. ...
  • Class II: Involves mild weakness of muscles other than ocular muscles. ...
  • Class IIa: Involves predominant weakness of the limb, axial muscles, or both. ...
  • Class IIb: Involves mostly oropharyngeal, respiratory muscles, or both.
Aug 8, 2022

What disease is similar to myasthenia gravis? ›

Beware: there are other diseases that mimic myasthenia gravis. A number of disorders may mimic MG, including generalized fatigue, amyotrophic lateral sclerosis (ALS), Lambert-Eaton myasthenic syndrome, botulism, penicillamine-induced myasthenia, and congenital myasthenic syndromes.

Is myasthenia gravis the same as ALS? ›

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction char- acterized by fluctuating muscle weakness and fatigability. By contrast, amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting motor neurons in the brain and the spinal cord.

At what age is myasthenia gravis usually diagnosed? ›

The disease occurs, for the most part, in the third decade, and is rare before the age of 15, or after 70. In approximately 60 per cent of the patients the disease develops between the ages of 20 and 40.

Who is most likely to get myasthenia gravis? ›

Myasthenia gravis affects the voluntary muscles of the body, especially those that control the eyes, mouth, throat and limbs. The disease can strike anyone at any age, but is more frequently seen in young women (age 20 and 30) and men aged 50 and older.

Are there mild cases of myasthenia gravis? ›

Myasthenia gravis can range from mild to severe. In some cases, symptoms are so minimal that no treatment is necessary. Even in moderately severe cases, with treatment, most people can continue to work and live independently. Life expectancy is normal except in rare cases.

Which medication is used to test for myasthenia gravis? ›

The Tensilon test uses the drug Tensilon (edrophonium) to help your doctor diagnose myasthenia gravis. Tensilon prevents the breakdown of the chemical acetylcholine, a neurotransmitter that nerve cells release to stimulate your muscles.

Can you drive with myasthenia gravis? ›

A common fear when first diagnosed with myasthenia is that you will never be able to drive again. This is not necessarily true, however anyone with myasthenia, who wishes to drive or holds a driving licence, is legally required to inform the Driver and Vehicle Licensing Agency (DVLA), even if their symptoms are mild.

What deficiency causes myasthenia gravis? ›

Background: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder. Vitamin D has important roles both in the autoimmune response and in skeletal muscles.

Which class of drug is most likely to worsen symptoms of myasthenia gravis? ›

Antibiotics and Anti-Malarials

The antibiotics most likely to worsen myasthenia are usually given in hospital, by injection, for very serious infections. The one exceptional drug that must be avoided in myasthenias is the ketolide antibiotic, Telithromycin (Ketek) which has caused deaths.

Can myasthenia gravis be caused by stress? ›

The study, “Prospective study of stress, depression and personality in myasthenia gravis relapses,” was published in the journal BMC Neurology. In addition to infections and medication, studies suggest that personality traits, coping mechanisms, stress, and depression can lead to relapses in MG.

What is the life expectancy with myasthenia gravis? ›

There is no cure for MG, but most people with the condition have a normal life span. Only 3 to 4 out of every 100 people with MG die because of MG. Years ago, early death occurred in over a third of people with MG.

What is the new treatment for myasthenia gravis 2022? ›

In April 2022, the U.S. Food and Drug Administration approved ULTOMIRIS® (ravulizumab-cwvz) for the treatment of generalized myasthenia gravis in adults who test positive for the acetylcholine receptor (AChR) antibody.

What drugs cause myasthenia gravis? ›

Prednisone was most commonly implicated as aggravating myasthenia gravis, and D-penicillamine was most commonly associated with myasthenic syndrome. The greatest frequency of drug-induced neuromuscular blockade was seen with aminoglycoside-induced postoperative respiratory depression.

Can you live a normal life with myasthenia gravis? ›

Thanks to advances in diagnosis and treatment, many people with myasthenia gravis , a rare autoimmune neuromuscular disorder, can expect to lead a normal or near-normal life.

What makes myasthenia gravis worse? ›

Extreme temperatures (hot or cold weather, hot showers or baths, sunbathing, saunas, hot tubs) Humidity. Sunlight or bright lights (affects eyes) Hot foods or beverages (affects mouth and throat)

How do you help someone with myasthenia gravis? ›

What can you do?
  1. Listen. Accept what the person has to say. Try to listen without diminishing or making light of their concerns. ...
  2. Be patient. A person talks when he or she is ready.
  3. Be flexible. Plans may have to change from day to day depending on how a person with MG feels.
  4. Offer help. Repeatedly.

What is the ice test for myasthenia gravis? ›

The diagnosis of the less obvious pure ocular form of the disorder can be greatly improved with the ice pack test as there are often no other features other than a ptosis. The test consists of the application of ice to the eyes for 2–5 minutes, ensuring that the ice is covered to prevent ice burns.

What is the best vitamin for myasthenia gravis? ›

Vitamin D:

A pilot study showed supplementation with vitamin D has beneficial effects on autoimmune response and may alleviate fatigue associated with myasthenia gravis.

Does myasthenia gravis get worse in heat? ›

For people who live with MG, hot weather can cause some unpleasant symptoms. Temperature extremes of either hot or cold may make you feel weak. Extremely hot temperatures, humidity, and sunlight all can make MG worse. Sunlight and bright lights can affect your eyes, too.

Is caffeine good for myasthenia gravis? ›

Caffeine isn't safe for everyone with MG, which is why it is important to know your own body. Personally, the temporary energy boost of caffeine outweighs the cons — for example, how Coke affects my stomach in conjunction with Mestinon (pyridostigmine).

How fast does MG progress? ›

Disease course

Over a longer term, the symptoms of MG usually progress, reaching maximum or near-maximum severity within one to three years of onset in most people. In about 15% of people, the disease remains ocular, but in most it becomes oculobulbar or generalized.

Is myasthenia gravis a form of MS? ›

While myasthenia gravis and multiple sclerosis share some similarities in the way they present, they are separate diseases with different causes, symptoms, treatments, and more.

Is myasthenia gravis a form of lupus? ›

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease and myasthenia gravis (MG) is an organ-specific autoimmune disease, both may exhibit positive anti-nuclear antibodies and a female preponderance. They may have similar features and can coexist in a patient or precede one another.

What is the difference between Guillain Barre and myasthenia gravis? ›

Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness in specific muscle groups, especially the ocular and bulbar muscles. Guillain-Barré syndrome (GBS) presents with ascending paralysis and areflexia, often secondary to an infection.

What psychiatric disorder is most commonly associated with myasthenia gravis? ›

Myasthenia gravis (MG) is a chronic illness most commonly found in women under 40 years. The most common psychiatric comorbidities found in MG include depressive and anxiety disorders.

What are the two types of myasthenia gravis? ›

There are two clinical forms of myasthenia gravis: ocular and generalized.

Does myasthenia gravis show up on an MRI? ›

Once myasthenia gravis has been diagnosed, your doctor will order images of your upper chest. CT and MRI scans will help show if the thymus gland is unusually large or whether it has a growth called a thymoma.

What happens if myasthenia gravis is left untreated? ›

If myasthenia gravis is left untreated, muscle weakness will progress fast, and you can become at risk of developing a myasthenic crisis, a life-threatening complication.

How accurate is the blood test for myasthenia gravis? ›

The anti–acetylcholine receptor (AChR) antibody (Ab) test is reliable for diagnosing autoimmune myasthenia gravis (MG). It is highly specific (as high as 100%, according to Padua et al).

Is myasthenia gravis hard to diagnose? ›

Myasthenia gravis (MG) can be difficult to diagnose because weakness is a common symptom of many disorders. Add to this the fact that symptoms may be vague, fluctuate or only affect certain muscles. And MG doesn't “perform” on demand; the eyelid that droops at 7 p.m. may not show for a 9 a.m. doctor appointment.

Which test would the nurse identify as specific for the diagnosis of myasthenia gravis? ›

A Tensilon test is a diagnostic test used to evaluate myasthenia gravis, which is a neuromuscular condition characterized by muscle weakness.

Can an eye doctor diagnose myasthenia gravis? ›

To diagnose myasthenia gravis, your ophthalmologist can conduct tests, including: a blood test to look for abnormal antibodies. neurological examination of your physical condition and mental skills.

What is similar to myasthenia gravis? ›

Beware: there are other diseases that mimic myasthenia gravis. A number of disorders may mimic MG, including generalized fatigue, amyotrophic lateral sclerosis (ALS), Lambert-Eaton myasthenic syndrome, botulism, penicillamine-induced myasthenia, and congenital myasthenic syndromes.

How quickly does myasthenia progress? ›

Muscle weakness caused by myasthenia gravis worsens as the affected muscle is used. Because symptoms usually improve with rest, muscle weakness can come and go. However, the symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease.

What medications should be avoided with myasthenia gravis? ›

Drugs to avoid

Commonly-used medications like ciprofloxacin or certain other antibiotics, beta-blockers like propranolol, calcium channel blockers, Botox, muscle relaxants, lithium, magnesium, verapamil and more, can worsen the symptoms of myasthenia gravis.

What diseases are associated with myasthenia gravis? ›

Thyroid disease is the most common associated with MG, rarely rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and other autoimmune diseases. Other diseases include hypertension, heart disease, diabetes, respiratory diseases, dyslipidemia.

Can I drive with myasthenia gravis? ›

Do not drive when you have double vision or weak neck muscles. Do not drive if your arms or legs are too weak to handle the car safely. If double vision or droopy eyelids start while you are driving, pull over and call for help. Use tape to keep droopy eyelids open while driving.

What is the best doctor to treat myasthenia gravis? ›

A rheumatologist specializes in treating autoimmune conditions like myasthenia gravis. This doctor may work with a neurologist to help find the right combination of treatments for a person with MG. Having a rheumatologist is especially important for people that have more than 1 autoimmune disorder.


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