Fast Five Quiz: Myasthenia Gravis Signs and Symptoms

Richard Nowak, MD, MS


July 08, 2021

Patients with anti-MuSK antibodies may have facial and tongue muscle atrophy, which can mislead clinicians to suspect amyotrophic lateral sclerosis.

In addition, patients with anti-MuSK antibody-positive MG have several clinical characteristics that differ from patients with the more common anti-AChR antibody-positive MG. Anti-MuSK antibody-positive MG is predominantly early onset and in women.

Patients with anti-MuSK antibodies may have severe faciopharyngeal weakness and report difficulty speaking and swallowing. Some patients have early respiratory and neck muscle weakness and have dyspnea and neck pain. Most patients with anti-MuSK antibody-positive MG have minimal ocular symptoms. Myasthenic crisis may also be more common among this patient subgroup due to bulbar phenotype.

Nonfluctuating and progressive symmetric ptosis points more strongly to a myopathic etiology (and not MG); in particular, chronic progressive externa ophthalmoplegia or oculopharyngeal muscular dystrophy.

Learn more about the clinical history of patients with MG.


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