A review of myasthenia gravis: Pathogenesis, clinical features and treatment

SummaryMyasthenia gravis is an organ-specific autoimmune disease characterised by fatigable weakness of voluntary muscles. It is associated with antibodies to the post-synaptic nicotinic acetylcholine receptor in the neuromuscular junction. It peaks in the 20s especially in women and in the 50s in men. Patients may present with a wide range of neurological symptoms but usually develop ptosis and/or diplopia at some point in their illness. Some patients may present with neuromuscular respiratory failure from the onset. Management is aimed at firstly treating the symptoms with acetylcholine esterase inhibitors, such as pyridostigmine, secondly treating the underlying disease process with immunosuppressants and thirdly considering thymectomy in patients with a thymoma and patients with generalised myasthenia. In this review, the important aspects of pathogenesis, diagnosis, investigation and management are discussed.