Fatigue and Fluctuating Symptoms in MG

Opinion
Video

Experts in neurology comment on fatigue and fluctuation of symptoms in MG and how that can contribute to a delay in diagnosis.

This is a video synopsis/summary of a panel discussion involving James Howard, MD; Nicholas Silvestri, MD, FAAN; Tuan Vu, MD; Ali Habib, MD; and Beth Stein, MD.

In diagnosing myasthenia, distinguishing between fatigue, sleepiness, and muscle weakness is crucial. Patients commonly report fatigue, which can be categorized into generalized fatigue typical of chronic illness and muscle fatigability, a hallmark of myasthenia gravis. Muscle fatigability manifests as fluctuating ability to perform activities throughout the day or between days, often affecting specific muscles rather than a generalized sense of fatigue. This distinction is vital for accurate diagnosis, as patients may appear normal during examination, leading to misinterpretation or delays in diagnosis.

The fluctuating nature of symptoms in myasthenia often leads to diagnostic delays. Patients presenting with fatigue may undergo extensive workups for common causes like sleep disorders or depression before neurologic evaluation. Diagnostic delays are particularly common in cases with infrequent or mild symptoms. Additionally, women with myasthenia may face delays due to misdiagnosis with psychiatric disorders, as their symptoms may not align with typical expectations. The variability and fluctuating nature of symptoms can significantly impact patients' quality of life and presentation to healthcare providers.

Improving diagnosis requires careful listening and understanding of patients' experiences. The unique variability of myasthenia symptoms necessitates a nuanced approach to history-taking and examination. By listening to patients and eliciting the subtleties of their symptoms, healthcare providers can enhance diagnostic accuracy and expedite appropriate management.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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