The following symptoms and complaints may indicate myasthenia gravis:
Leading symptoms
- Exercise-dependent muscle weakness after muscle activity; exhaustion occurs rapidly after a few repetitive movements
Secondary symptoms
- Ptosis (drooping of the eyelid; “bedroom gaze”).
- Diplopia (double vision)
- Often weakness of the muscles of the extremities, usually the arms are affected more than the legs in the course
- Sometimes weak, sometimes normal strong handshake (“milkmaid grip”).
- Head hold weakness due to weakness of the neck / neck muscles.
- Bulbar symptoms when mouth and tongue muscles and/or chewing and pharyngeal muscles are affected: increased salivation, tongue marginal atrophy (lateral tongue muscle atrophy), tongue fasciculation (involuntary fine twitching of the tongue), inappropriate laughing or crying, altered voice, speech disorders
- Dysarthrophonia (nasal pronunciation).
- In advanced stages, the respiratory muscles may be affected, so that ventilation is required
- Limited vital capacity (parameter for the function of the lungs).
- If the swallowing muscles are affected, a gastric tube (PEG tube; endoscopically created artificial access from the outside through the abdominal wall into the stomach) is placed for supportive or complete care
- Leakage of fluid from the nose when swallowing.
Initial symptoms
- > 50% onset of ocular (affecting the eyes) symptomatology, e.g., unilateral or bilateral ptosis and/or double vision (may be transient, worsen with exertion, and change over the course of the day; does not follow a pattern)
- Approximately 14% beginning with dysphagia and speech disorders.
- Approximately 8% beginning with arm or leg weaknesses.
- Very rare onset in trunk and spine muscles.
Muscle weakness may also increase during the day for no apparent reason. At rest, it decreases again.The symptoms are not rigid in their occurrence and intensity, but changing. Initially, usually only small muscles are affected. Smooth muscle and cardiac muscles are not affected because they do not have a motor end plate.
Note: Impaired balance, degenerative memory, and sensory disturbances are not signs of myasthenia gravis!
Myasthenic crisis
- Severe increase in muscle weakness
- Dysphagia (difficulty swallowing)
- Dysarthria (speech disorder)
- If necessary, paralysis of the swallowing and breathing muscles.
Associated symptoms
- Signs of cholinergic crisis with
- Fasciculations (involuntary fine twitches of small bundles of muscle fibers) and spasms of the muscles (nicotinic action)
- Hypersecretion (greatly increased production of bodily fluids such as saliva).
- Bradycardia (too slow heartbeat: < 60 beats per minute).
- Diarrhea (diarrhea; muscarinic effect).
Occurrence of myasthenic crisis often associated with infections in patients with prolonged myasthenia. Note: A myasthenic crisis is a neurological emergency situation and always requires intensive medical treatment.
