Myastenia gravis

Management escalation pathway

• Steroids indicated (oral or i.v.)
• Pyridostigmine initial dose 30 mg
• Neurological consult If no improvement, or worsening, plasmapheresis or IVIG may be considered
• Avoid certain medications, that may precipitate cholinergic crisis (e.g. ciprofloxacin, beta blockers, amikacin, benzodiazepines and above all curares during general anesthesia)’)

Assessment and Investigations

• Check for ocular muscle and proximal muscle fatigability AChr and MuSK antibodies
• Bedsides tests, e.g. Tensilon test or ice pack test with neurological input
• Repetitive nerve stimulation and single fibre EMG
• Exclude myocarditis with cardiac enzymes (and cardiac MRI in case of doubt) (cave pseudo myasthenic myositis)