Myasthenia Gravis

Abstract

Our concept of myasthenia gravis has evolved from: (1) its recognition as a clinical syndrome first enunciated by T. Willis in the 17th century¹; (2) its more precise exposition by Erb in 1879 and by Goldflam in 1893¹(whence the designation Erb-Goldflam disease); (3) an effective treatment by anticholinesterase agents introduced by Walker in 1934²; (4) its pharmacodiagnosis by means of intramuscular neostigmine (Prostigmine), described by Viets and Schwab in 1935,³improved later by the use of intravenous edrophonium chloride (Tensilon)⁴; (5) its curious association with thymic hyperplasia and sometimes with thymomas^5,6; (6) a significantly frequent association of a myasthenic syndrome with dysthyroidism, bronchogenic carcinoma,⁷and with some of the autoimmune diseases⁸; and (7) a characteristic fatigue pattern demonstrable by electromyography, which may be of diagnostic significance.⁹ The extraocular muscles and orbicularis oculi are the muscles most commonly affected. Approximately half