The clinical evaluation of myasthenia gravis

The diagnosis of myasthenia gravis (MG) is strongly considered in a patient complaining of fatigable weakness and in whom muscle fatigability is demonstrated during bedside examination. This chapter will be dedicated to the history-taking and clinical examination of patients with MG and we will also touch upon other myasthenic syndromes and mimics. Most patients first experience fatigable ocular symptoms. The symptoms may remain isolated to the eyes (ocular MG) or later involve the limb, bulbar or respiratory muscles (generalized MG). The examination of the myasthenic patient serves to demonstrate fatigability and distinguish this from non-specific central fatigue or lack of energy. This chapter presents a focused discussion by a neuro-ophthalmologist and neurologists, largely based on their clinical experience.