Myasthenia gravis

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Myasthenia gravis often presents initially with extraocular muscle involvement. The levator muscle is usually the first muscle involved. In 20 per cent of patients, signs and symptoms are confined to the eye muscles throughout the disease these cases are classified as ocular myasthenia gravis. Involvement beyond the ocular muscles is described as generalised disease. A hallmark of the disease is variability and fatigability.

Symptoms

Patients experience exacerbations and remissions, especially in the early stages. Ocular symptoms often appear first, and include eyelid droop and diplopia. Generalised symptoms include limb or facial muscle weakness, and difficulty with swallowing, breathing or speech. Symptoms are usually worse with sustained effort and towards the end of the day.