Clinical neuropharmacology patient mangement series - Myasthenia gravis

A 33-year-old woman is evaluated for drooping of the left eyelid and interm ittent double vision of 1 month duration. She states that her symptoms fluc tuate and are worse toward the end of the day and during warm weather. Ther e are no complaints of general muscle fatigue, voice changes, or chewing or swallowing problems. There is no medical or family history and she takes o nly multiple vitamin supplements. Her examination reveals 40% left-sided pt osis with equally sized, normally reacting pupils. There is bilateral medic al rectus and left superior rectus fatigable weakness. Face, palate, tongue , axial, and limb muscle strength are all normal. Acetylcholine receptor bi nding antibodies were not detected and thyroid function was normal.