I. Introduction to Myasthenia Gravis (MG)

Myasthenia gravis is an autoimmune neuromuscular disorder in which nerve signals cannot be effectively transmitted to the muscles, resulting in muscle weakness. The affected muscles may include those controlling the eyes, facial expressions, chewing, swallowing, limbs, and breathing. The age of onset shows a bimodal distribution, with a higher prevalence in women aged 20–30 years and in men over 50 years of age. Approximately two-thirds of patients have thymic hyperplasia, and about 25% have thymoma.

II. Symptoms

MG is categorized into ocular and generalized types, with about 50% of ocular patients progressing to the generalized form within two years. The hallmark of MG is "fatigability": muscle strength declines with activity and improves with rest. Symptoms are typically milder in the morning and worsen by evening. When facial muscles are affected, patients may exhibit a stiff expression or a “myasthenic smile.” If bulbar muscles, which control chewing, swallowing, and speech, are involved, patients may experience nasal speech, slurred articulation, dysphagia, or coughing/choking while drinking.

III. Treatment

Once myasthenia gravis is diagnosed, the treatment goal has shifted from simple symptom control to improving quality of life and achieving long-term disease remission. Physicians adopt a staged, precision-based treatment strategy tailored to the patient’s antibody profile, disease severity, and clinical manifestations.

Ⅳ. Precaution

Patients with myasthenia gravis require careful management of physical activity and environmental triggers to maintain stable disease control. The following care recommendations are suggested:

• Energy Conservation: Plan activities during periods of peak strength, usually in the morning. Incorporate regular short rest periods to prevent excessive muscle fatigue.

• Avoid Triggers: Consult a neurologist before taking any new medications, including antibiotics, beta-blockers, or magnesium supplements, to avoid exacerbation of muscle weakness. Even mild infections, such as a cold or fever, may trigger symptom fluctuations; follow medical advice regarding regular vaccinations. Avoid excessive physical exertion, emotional stress, and exposure to extreme heat.

• Dietary Management: For patients with muscle weakness affecting chewing or swallowing, choose soft, nutrient-dense foods. Avoid dry or large pieces of food to reduce the risk of choking or aspiration pneumonia. During meals, sit upright and tuck the chin slightly toward the chest to facilitate safer swallowing.

• Lifestyle Recommendations: Encourage moderate physical exercise. Regular activity helps maintain muscle strength and overall quality of life.

Patients with myasthenia gravis require careful management of physical activity and environmental triggers to maintain stable disease control. The following care recommendations are suggested:

• Energy Conservation: Plan activities during periods of peak strength, usually in the morning. Incorporate regular short rest periods to prevent excessive muscle fatigue.

• Avoid Triggers: Consult a neurologist before taking any new medications, including antibiotics, beta-blockers, or magnesium supplements, to avoid exacerbation of muscle weakness. Even mild infections, such as a cold or fever, may trigger symptom fluctuations; follow medical advice regarding regular vaccinations. Avoid excessive physical exertion, emotional stress, and exposure to extreme heat.

• Dietary Management: For patients with muscle weakness affecting chewing or swallowing, choose soft, nutrient-dense foods. Avoid dry or large pieces of food to reduce the risk of choking or aspiration pneumonia. During meals, sit upright and tuck the chin slightly toward the chest to facilitate safer swallowing.

• Lifestyle Recommendations: Encourage moderate physical exercise. Regular activity helps maintain muscle strength and overall quality of life.

VI. Conclusion

The course of myasthenia gravis is characterized by fluctuating fatigability. Although symptoms may vary with physical exertion, please do not feel anxious. With consistent medication, moderate activity, and careful self-monitoring, most patients can maintain a good quality of life.

You are the most vital member of your care team. Please remain attentive to subtle changes in your body. In particular, if you experience difficulty swallowing, slurred speech, or breathing difficulties, please contact your medical team immediately. By adhering to regular follow-ups and maintaining consistent medication compliance, we will stand by your side to safeguard your stability and support your quality of life.

VII. References

1.   Li, H.-H., Lin, L.-C., Hu, Y.-C., Huang, Y.-C., Wu, P.-Y., Hsiao, S.-M., Yang, W.-P., Chiang, L.-C., Lin, K.-M., Lin, C.-C., Hsu, Y.-Y., Hsieh, C.-M., Tu, L., Chen, H.-C., Liu, C.-H., Fu, C.-Y., Kuo, S.-F., Tsai, L.-S., Chang, C.-L., ... Ko, H.-K. (2024). Adult medical-surgical nursing (Vol. 2, 7th ed.). Hua Xing Publishing.

2.   Binks, S. N. M., Morse, I. M., Ashraghi, M., Vincent, A., Waters, P., & Leite, M. I. (2025). Myasthenia gravis in 2025: Five new things and four hopes for the future. Journal of Neurology, 272(3), Article 226. https://doi.org/10.1007/s00415-025-12922-7

3.   Gilhus, N. E., Andersen, H., Andersen, L. K., Boldingh, M., Laakso, S., Leopoldsdottir, M. O., Madsen, S., Piehl, F., Popperud, T. H., Punga, A. R., Schirakow, L., & Vissing, J. (2024). Generalized myasthenia gravis with acetylcholine receptor antibodies: A guidance for treatment. European Journal of Neurology, 31(5), e16229. https://doi.org/10.1111/ene.16229

4.   Taiwan Neuroimmunology Medical Society. (2024). Myasthenia gravis clinical care guidelines (1st ed.). Taiwan Neuroimmunology Medical Society. https://www.tnms.com.tw/wp-content/uploads/2025/04/%E5%8F%B0%E7%81%A3%E7%A5%9E%E7%B6%93%E5%85%8D%E7%96%AB%E9%86%AB%E5%AD%B8%E6%9C%83_%E8%82%8C%E7%84%A1%E5%8A%9B%E7%97%87%E8%87%A8%E5%BA%8A%E7%85%A7%E8%AD%B7%E6%8C%87%E5%BC%95%E6%89%8B%E5%86%8A2024_vFinal-31-Mar%E6%8B%B7%E8%B2%9D.pdf