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Myasthenia gravis It is an autoimmune disease which affects neuromuscular junction. It is a defects in transmission of nerve impulses to muscle at neuromuscular junction. It mostly affects to women who is under 40. Clinical presentation Weakness worsens as day progress then morning. - specific muscle weakness ( mostly ocular symptoms) - ptosis - diplopia (double vision) - asymmetrical eye weakness - facial muscle weakness (trouble smiling or whistling) - bulbar weakness - neck flexor weakness - limb weakness - respiratory muscle weakness Classification Myasthenia Gravis Foundation of America Clinical Classification - Class I: Any ocular muscle weakness, possible ptosis, no other muscle weakness - Class II: Mild weakness - Class IIa: affecting limb, axial muscles, or both, lesser involvement of oropharyngeal muscles. - Class IIb: Predominantly bulbar or respiratory muscles; may also have lesser or equal involvement of limb, axial muscles pr both - Class III: Moderate weakness - Class IIIa: affecting limb, axial muscles, or both; lesser involvement of oropharyngeal muscles - Class IIIb: bulbar and/or respiratory muscles - Class IV: Severe weakness - Class IVa: affecting limb, axial muscles, or both - Class IVb: bulbar and/or respiratory muscles - Class V: To maintain airway Intubation needed

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