Myasthenia gravis (MG) is an autoimmune condition that causes muscle weakness which worsens with use and improves with rest — a pattern called fatigable weakness. It happens because antibodies interfere with the signal between nerve and muscle at the neuromuscular junction.
The name sounds alarming, but the outlook is genuinely positive: MG is one of the most treatable conditions in neurology, and the last few years have brought a wave of powerful new therapies. With modern treatment, the great majority of people with MG can expect good control of their symptoms and a normal or near-normal life.
What is myasthenia gravis?
In most people the antibody targets the acetylcholine receptor (AChR) on muscle. In others it targets MuSK or LRP4, and some people are “seronegative” — no antibody is found on current tests, but the clinical picture fits. Identifying the antibody guides treatment, because the subtypes respond differently.
Symptoms
👁️ Eye symptoms (often first)
Drooping eyelids (ptosis) and double vision (diplopia).
🗣️ Bulbar symptoms
Slurred speech, difficulty chewing or swallowing.
💪 Limb weakness
Typically worse later in the day or after exertion.
🫁 Breathing muscles
In severe cases; a “myasthenic crisis” affecting breathing is a medical emergency.
The hallmark is fatigability — strength that fades with repetition and recovers after rest.
How myasthenia gravis is diagnosed
🧪 Antibody blood tests
Acetylcholine receptor (AChR) first, and if negative, MuSK. LRP4 antibody testing is controversial and is not currently available in Australia.
⚡ Nerve and muscle studies
Repetitive nerve stimulation and single-fibre EMG (electromyography); single-fibre EMG is the most sensitive test for MG.
🧊 Ice-pack test
A simple bedside test that can temporarily improve a drooping eyelid.
🩻 CT scan of the chest
To look for a thymoma (a tumour of the thymus gland that can drive MG).
Modern treatment of myasthenia gravis
Treatment is tailored to your antibody type, severity, age and other health conditions. The 2026 toolkit is broad:
| Approach | Examples |
|---|---|
| Symptom relief | Pyridostigmine |
| Immune-suppressing tablets | Prednisolone, azathioprine, mycophenolate mofetil |
| Rapid / rescue treatment | Intravenous immunoglobulin (IVIG), plasma exchange (PLEX) |
| Complement inhibitors (AChR-positive generalised MG) | Eculizumab (Soliris), ravulizumab (Ultomiris), zilucoplan (Zilbrysq) |
| FcRn antagonists | Efgartigimod (Vyvgart), rozanolixizumab (Rystiggo) |
| Refractory disease | Rituximab (especially MuSK-positive); cyclophosphamide, which has good evidence in selected refractory cases |
| Surgery | Thymectomy — essential for thymoma, and helpful in selected AChR-positive generalised MG |
MuSK-antibody MG often responds particularly well to rituximab. The newer complement inhibitors and FcRn (neonatal Fc receptor) antagonists have transformed care for people whose MG was previously hard to control.
Myasthenic crisis is an emergency: rapidly worsening weakness affecting breathing or swallowing needs urgent hospital care, where it is treated with plasma exchange or IVIG and breathing support. If in doubt, call 000.
Thymectomy and the thymus
The thymus gland is often involved in MG. Removing it (thymectomy) is essential when a thymoma is present, and can also reduce symptoms and medication needs in selected people with generalised AChR-positive MG, particularly younger adults.
Pregnancy and myasthenia gravis
Most women with MG can have healthy pregnancies with planning. Some medications are continued and others avoided, so pre-pregnancy discussion is important. A small number of babies have temporary, treatable weakness at birth that settles within weeks.
Reassuring: with the modern range of treatments, most people with MG achieve good symptom control — and many reach minimal or no symptoms.
Myasthenia gravis care at East Neurology
Dr Tal Koren manages myasthenia gravis at East Neurology in Bondi Junction — from diagnosis (antibodies and neurophysiology) through to modern treatment selection, monitoring and crisis planning — and is a credentialled neurophysiologist. He works alongside Dr Ron Granot and the wider team.
Frequently asked questions
Is myasthenia gravis curable?
There is no permanent cure, but it is highly treatable — many people reach minimal or no symptoms on treatment, and some achieve lasting remission.
Will my eye symptoms spread to the rest of my body?
Some people have only eye involvement (ocular MG); in others it becomes generalised, usually within the first couple of years. Your neurologist will monitor for this and adjust treatment.
Are the new MG drugs available in Australia?
Yes — complement inhibitors and FcRn antagonists are in Australian use, with access criteria that change over time. We will advise what applies to your situation.
Related reading
- Neuroimmunology — overview of conditions and team
- GBS and CIDP — other immune nerve conditions
- Neurophysiology and EEG testing
- Dr Tal Koren — Consultant Neurologist (Neuroimmunology)
External resources
- Myasthenia Alliance Australia — patient information and support
This page is general information about myasthenia gravis and is not personal medical advice. Please contact the practice to discuss your individual situation.
Book an appointment
To arrange a consultation about myasthenia gravis with Dr Tal Koren, ask your GP or specialist for a referral, then get in touch — new patients and second opinions are welcome.
Or call 02 9388 0615. East Neurology is a private practice; we do not bulk bill (including DVA cardholders) — Medicare claims are processed for you on the day.