From my experience, the MG diagnosis checklist of the future would have some very basic guidelines already even at the doctor´s office.

Perhaps starting off something like this:

1. Ask patient questions
2. Ask which of the patient´s muscles are the weakest
3. Elicit myasthenic weakness by observing repetitive movements of muscles where possible. Apply resistance.
4. Refer patient for necessary blood tests, CT scan and SFEMG

5. Refrain from making random, out-of-context assumptions - such as the following:


• Patient must be lazy if they complain of muscle weakness with repetitive activity

• Patient must be overanxious if they complain of respiratory distress

• Patient must be anorexic or be worried about weight gain if they have problems chewing their food

• Patient must have been drinking before if speech suddenly becomes slurred and unintelligible during appointment

• Patient has difficulties climbing stairs or getting up off the floor because he lacks will power

• Patient can safely increase overall fitness level at gym – (and then, unexplained swallowing weakness, epiglottis reaction times and droopy eyes might even disappear - along with the patient. That is, if ignored long enough by doctor)

• Patient must be depressed if unable to participate in evening social activities involving taking dog for a walk, sitting through a film or eating out with family and best friends.

• Patient can not possibly be experiencing fatigable muscle weakness during the SFEMG test if that test is negative

• Patient must have imagined muscle weakness if all tests are negative

• Patient´s hypoxia symptoms onboard an aircraft are caused by a fear of flying

• Patient has inadvertently contracted a new psychosomatic illness when weakness spreads to a different muscle set

• Patient needs immediate referral to psychiatric ward if he/she complains that by using one muscle set, weakness appears in another totally unrelated set of muscles

• Patient´s gradually weakening facial muscles at appointment are a sign of reluctance to show appreciation of extensive knowledge, skill and advice of doctor


Then perhaps in the future some of those diagnoses taking eight years may be reduced to only four!!!!


Anacrusis