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Especially ocular, bulbar, limb, and respiratory muscles Pathophysiology Thymus involvement Muscle-like (myoid) cells in the thymus express AChR autoreactive targeting by T cells production of acetylcholine receptor antibodies (AChR antibodies) Acetylcholine receptor antibodies [4] Responsible for inhibition of signal transduction at the neuromuscular junction (NMJ) Antibodies target postsynaptic AChRs of normal muscle cells competitive inhibition of acetylcholine (ACh) AChR decay through receptor internalization ( receptor density at the postsynaptic membrane) and activation of complement ( muscle cell lysis) impaired signal transduction at the NMJ skeletal muscle weakness and fatigue Seropositive MG (8090% of cases): positive assays for antibodies (in blood) against the acetylcholine receptor (AChR-Ab) Seronegative MG (1020% of cases): negative for AChR antibodies, but may be positive for muscle-specific tyrosine kinase antibodies (MuSK antibodies) Clinical features Symptoms [5] Severity typically varies during the day and from day to day Fatigable weakness of skeletal muscles that worsens with increased muscle use and improves with rest

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