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.
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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 Personal emails, About story and Australian-style copy