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Myasthenia Gravis

MG or something else?



I am a medical student (28) who has been suffering considerable fatigue for the last two years. It began in my right eye and legs and over 6-12 months, spread to the other eye and then arms. The fatigue is felt first thing in the morning, literally upon awakening. It can be intermittent in the arms and legs (eg feeling of weakness for circa a week) though the eye fatigue, particularly the eyelids, is continuous (first thing in the morning which can worsen as the day progresses). I simply feel like I always need to close or rub my eyes (my eyes were checked by an opthamologist when these symptoms began). I also have intermittent fasciculations in my eyelids and limbs (which I never had preceding the onset of the fatigue). I have no double vision nor any facial weakness. I can still lift weights but something like holding a cell phone causes my arm to tire within a few minutes.

I have seen a neurologist whose physical exam found nothing remarkable. He suggested an EMG for reassurance but I am reluctant due to it not being the most pleasurable of experiences!

I would be most appreciative of any suggestions you might offer as this is driving me round the bend! Do you feel an EMG is warranted despite no major evidence found during a physical exam or whether this may be something else like CFS? My concern of a neurological disorder stems particularly from the eyelid fatigue that was initally unilateral before becoming bilateral and the progression of fatigue from the legs to include the arms.

As well, from your experience, what does weakness present like in general for MG sufferers, for example, can they lift weights etc... and would fatigue be present first thing in the morning despite minimal exertion?

Many thanks for any help you can provide


The weakness of myasthenia is usually described as fatiguing, meaning people are doing well first thing in the morning and after resting. They usually notice more symptoms as the day progresses or they are more active. Lifting weights, especially doing multiple repetitions in a set and multiple sets, sounds unusual to me.

Chronic fatigue syndrome and myasthenia definitely in the same differential. Luckily, they vary in level of physical danger. Even the EMG has a sensitivity of 70-80%, so when it is normal, it does not rule myasthenia out—it just makes it less likely. But it might catch something that the physical exam can't catch—inflammation in the muscle. There are other conditions beside CFS that can make you feel weak.

You have already made the first and best step by seeing a physician. The next step is regular follow-up with that neurologist. If there is an underlying problem, it will eventually declare itself. Look at your diet. Eating more fresh foods and eliminating artificial sweeteners has had a positive impact on my own fatigue. Good luck.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati