Myasthenia Gravis: Symptoms, Crisis Signs and Rehabilitation

Myasthenia Gravis, commonly shortened to MG, is a chronic autoimmune neuromuscular condition that causes fluctuating weakness in voluntary muscles. Weakness often becomes more noticeable with activity and may improve after rest.

What Is Myasthenia Gravis?

MG affects communication between nerves and muscles at the neuromuscular junction. In autoimmune MG, antibodies interfere with proteins needed for nerve signals to activate skeletal muscles effectively.

The weakness is not simply ordinary tiredness. It may vary during the day, worsen after repeated use and affect different muscle groups from one person to another.

Common Symptoms

Why Symptoms Can Fluctuate

Symptoms may be milder after rest and worse after repeated activity. Infection, heat, emotional stress, surgery and certain medicines may also worsen weakness in some people.

Do not stop, start or change medication based on an article. People with MG should check new medicines, supplements and over-the-counter products with their neurologist, doctor or pharmacist because some may aggravate symptoms.

How Is MG Diagnosed?

A neurologist may use the clinical history, physical examination, antibody tests, electrical studies and imaging of the thymus. Other conditions can cause similar symptoms, so weakness should not be self-diagnosed.

Treatment depends on the MG subtype, symptoms and medical status. It may include medication, therapies that alter the immune response and, for selected people, thymus surgery. These decisions belong to the neurology team.

Myasthenic Crisis Is a Medical Emergency

Breathing weakness may not always look dramatic at first. Do not wait for the person to become exhausted or blue before seeking help.

What Is the Role of Physiotherapy?

When MG is medically stable, physiotherapy may help maintain mobility, strength, balance and participation in daily activities. The programme must reflect fluctuating weakness and avoid excessive fatigue.

• Assess mobility, transfers, walking and falls risk.
• Plan short activity periods with adequate rest.
• Use low-to-moderate exercise only when clinically appropriate.
• Monitor form and stop before weakness causes unsafe compensation.
• Provide strategies for safe movement and energy conservation.
• Coordinate with neurology, respiratory, speech therapy and occupational therapy when required.

Pacing Daily Activities

Pacing means planning tasks before fatigue becomes severe. It is not complete inactivity. The person may break tasks into smaller stages, alternate demanding and lighter activities and schedule rest before weakness interferes with safety.

Where possible, important activities may be planned for the time of day when strength is usually better and in relation to the medical plan set by the treating team.

Exercise Principles for Stable MG

• Begin below the level that triggers marked weakness.
• Use short sets and longer recovery periods.
• Avoid exercising to failure or trying to push through deteriorating form.
• Keep the environment cool if heat worsens symptoms.
• Choose seated or supported options when balance is limited.
• Stop if speech, swallowing, vision, neck control, gait or breathing worsens.
• Review prolonged post-exercise deterioration with the medical team.

Eating, Swallowing and Communication

Difficulty chewing or swallowing requires medical review and may need assessment by a speech and language therapist and dietitian. Physiotherapists should not provide swallowing treatment outside their scope.

Practical planning may include eating when strength is better, allowing adequate time and following texture or posture advice provided by the swallowing team. Choking or inability to manage saliva requires urgent attention.

Multidisciplinary Care

MG management may involve neurology, nursing, respiratory care, physiotherapy, occupational therapy, speech and language therapy, dietetics and primary care. The exact team depends on the person’s symptoms and goals.

When to Contact the Medical Team

• Weakness is becoming more frequent or severe.
• New double vision, eyelid drooping or neck weakness appears.
• Walking, transfers or daily tasks become less safe.
• Chewing, speaking or swallowing becomes more difficult.
• Symptoms change after starting a medicine or during infection.
• Recovery after ordinary activity is taking progressively longer.

Frequently Asked Questions

References

• NINDS: Myasthenia Gravis Fact Sheet
• NHS: Myasthenia Gravis
• NHS: Myasthenia Gravis Treatment

Medical note: This page is for general education and does not replace neurological diagnosis, medication advice or emergency care.