Myasthenia gravis
Fatigable ocular, bulbar and proximal weakness, AChR and MuSK antibodies, CT for thymoma, pyridostigmine then steroids and steroid-sparing therapy, thymectomy after MGTX, crisis management, the drugs that worsen MG, and the new FcRn and complement agents on the PBS.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Autoimmune disease of the postsynaptic neuromuscular junction. Antibodies against the acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or LRP4 reduce the safety factor of transmission. The mechanism is in Synaptic transmission at the neuromuscular junction.
- Bimodal onset: young women (often thymic hyperplasia) and older men (increasingly common, often missed).
- Hallmark: fatigable weakness of ocular, bulbar, neck and proximal limb muscles, worse at the end of the day. Reflexes and sensation are normal.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: NeurologyAU/NZTherapeutic Guidelines Limited
- International consensus guidance for management of myasthenia gravis: 2020 update (Narayanaswami P et al. Neurology 2021;96(3):114-122)Neurology, 2020 (published 2021)
- Generalized myasthenia gravis with acetylcholine receptor antibodies: a guidance for treatment (Gilhus NE et al. Eur J Neurol 2024;31(5):e16229)European Journal of Neurology, 2024
- Practical guidance on initiating and switching targeted immunotherapies in generalised myasthenia gravis: a German-Austrian expert opinion paper (Meisel A et al. Eur J Neurol 2026;33(9):e70747)European Journal of Neurology, 2026
- Randomized trial of thymectomy in myasthenia gravis (MGTX; Wolfe GI et al. N Engl J Med 2016;375:511-522)New England Journal of Medicine, 2016
- A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis (Zisimopoulou P et al. J Autoimmun 2014)Journal of Autoimmunity, 2014
- Criteria for the clinical use of immunoglobulin in Australia: myasthenia gravisAU/NZNational Blood Authority
- PBS Schedule: rozanolixizumab (Rystiggo) and zilucoplan (Zilbrysq), acute severe, bridging and treatment-refractory generalised myasthenia gravisAU/NZPharmaceutical Benefits Scheme, Checked November 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback