Summary
Definition
History and exam
Key diagnostic factors
- fatigabilidade da força muscular
- ptose
- diplopia
- disfagia
- disartria
- paresia facial
- fraqueza muscular proximal
- dispneia
Risk factors
- história familiar de distúrbios autoimunes
- marcadores genéticos
- terapia dirigida ao câncer
Diagnostic tests
1st tests to order
- análise de anticorpo sérico antirreceptor da acetilcolina (AchR)
- anticorpos antitirosina quinase músculo-específica (MuSK)
- testes seriados de função pulmonar
Tests to consider
- testes de anticorpos antirreceptor de músculo estriado
- estimulação nervosa repetitiva
- eletromiografia (EMG) de fibra única
- tomografia computadorizada (TC) do tórax
Treatment algorithm
crise miastênica
doença leve a moderada (classe I a III)
doença grave (classe IV ou V) ou refratária
Contributors
Authors
David P. Richman, MD
Distinguished Professor
Professor of Neurology
University of California - Davis
Davis
CA
Disclosures
DPR declares that he has no competing interests.
Acknowledgements
Dr David Richman would like to gratefully acknowledge Dr Robert Lisak, Dr Andrea Corse, and Dr Ami Mankodi, previous contributors to this topic.
Disclosures
AC and AM declare that they have no competing interests. RPL is a Data and Safety Monitoring Board Member for the COUR myasthenia gravis clinical trial. RPL is a site principal investigator for clinical trials and a co-author for the clinical trial reports for myasthenia gravis therapies for Alexion, Argenx, and UCB Ra. RPL's institution receives payment for the time spent on these clinical trials. RPL has received book royalties from Oxford University Press and Blackstone, and has carried out consultancy work for Avilar.
Peer reviewers
Vern C. Juel, MD
Associate Professor of Medicine (Neurology)
Duke University
Durham
NC
Disclosures
VCJ declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021 Jan 19;96(3):114-22.Full text Abstract
Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol. 2010 Jul;17(7):893-902.Full text Abstract
Gronseth GS, Barohn R, Narayanaswami P. Practice advisory: thymectomy for myasthenia gravis (practice parameter update). Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2020 Apr 21;94(16):705-9.Full text Abstract
Elovaara I, Apostolski S, van Doorn P, et al. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol. 2008 Sep;15(9):893-908.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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