From my experience, the more experienced and knowledgable MG experts are, the less likely they are to be able to truly think "out of the box" and understand the complexity of the myasthenic sydromes.

They are also probably more afraid then others to make a wrong diagnosis of this illness, or treat a patient for MG symptoms when they are "central". A young and relatively inexperienced neurologists can "take the risk" of being told by a colleague that his patient doesn't "really" have MG. Someone like the neurologist you went to, "can't afford" to be in such a situation.

It is very similar to the "Emperor's new clothes". They all know there is a significant problem in their diagnosis and management tools, and will admit this in private conversations, but none is ready to be the first one to publicly say this.

Also, this specific neurologist, you are talking about, was recently a co-author of a paper in M&N that showed that even in patients with classical seropositive MG, and a decremental response on EMG studies, there is no "true" fatigable muscle weakness.

Muscle strength and fatigue in patients with generalized myasthenia gravis
Caitlin J. Symonette, MSc 2, Bradley V. Watson, BSc 1, Wilma J. Koopman, MSCN, RN 1, Michael W. Nicolle, MD, DPhil 1, Timothy J. Doherty, MD, PhD 1 *


this is one of the "pearls" from this paper-

"In keeping with previous studies that showed a higher rate of experienced fatigue in patients with neuromuscular diseases, some patients may have central weakness as a result of lack of effort, and this is sometimes difficult to differentiate from true fatigable weakness".

alice