ABSTRACT
Myasthenia gravis may start with weakness and exhaustibility in any voluntary muscle group. The most common initial complaints are diplopia or drooping of one upper eyelid occurring in 50 to 65% of the patients. The maximal severity is reached in the first year in about two thirds of the patients, in 70 to 90% in the third to fifth year. In 10 to 15% of the patients the signs remain clinically confined to the ocular muscles and the eyelids. If other muscles are affected the disease is called generalized, but the degree of clinical involvement may vary widely from patient to patient, and may be obviously asymmetrical. In the survivors the disease tended to improve gradually with spontaneous clinical remission in 20 to 25%, occurring at any time of the course. The early and predominant affection of the eye-moving muscles and of the palpebral levator is a clinically important feature of Myasthenia gravis in about 50 to 60% of the patients.
