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Myasthenia Gravis

A long-term autoimmune condition in which the signals between nerves and muscles are blocked, causing muscle weakness that worsens with use and improves with rest — often drooping eyelids, double vision, or trouble chewing, swallowing or speaking. There is no cure, but treatment helps most people. Trouble breathing or swallowing is an emergency.

Call 911 right away for shortness of breath, severe trouble swallowing or choking, or if you cannot walk or talk (Myasthenia Gravis Foundation of America, MGFA). These can be signs of a myasthenic crisis, when the breathing muscles become too weak to work and a machine may be needed to breathe; it needs immediate emergency care (NINDS).

  • A crisis usually builds over days to weeks of worsening symptoms, but rarely it comes on faster (MGFA). Call your doctor about any flare — worse double vision, slurred speech, arm weakness, falls or swallowing trouble — so it can be treated before it becomes a crisis (MGFA).
  • Infection, stress, surgery or a reaction to a medicine can set off a crisis (NINDS). Tell every doctor, dentist and pharmacist that you have MG before starting any new medicine (MGFA).
  • If you take pyridostigmine (Mestinon), don’t take extra doses on your own when you feel weaker: too much can also cause dangerous weakness, and the two can be hard to tell apart (Mestinon label). Call your doctor or 911.

What is myasthenia gravis?

Myasthenia gravis (MG) is a long-term neuromuscular disease that weakens the voluntary muscles — those that move the eyes, face, throat and limbs and help you breathe (NINDS). It is autoimmune: the immune system makes antibodies that block, change or destroy the receptors for acetylcholine, the chemical nerves release to make a muscle contract (NINDS). Most often the antibodies target that receptor (AChR); in others they target a related protein, MuSK (MedlinePlus Genetics). The heart and digestive muscles are not affected (MGFA).

The thymus, an immune gland behind the breastbone, seems to play a part: about 75% of people with MG have a large, overactive thymus (MedlinePlus Genetics), and around 1 in 10 have a thymus growth called a thymoma (NHS), which is usually not cancer but can become cancerous (NINDS).

Who gets it?

MG affects about 20 in every 100,000 people worldwide (MedlinePlus Genetics). It can start at any age, including childhood, but is most common in women under 40 and men over 60; it is not contagious and usually not inherited (NINDS). People with MG are more likely to have other autoimmune conditions, such as autoimmune thyroid disease and lupus (MedlinePlus Genetics) — see our Lupus and Graves’ Disease guides; a Thyroid guide is on the way.

Symptoms

The hallmark is weakness that gets worse with use and better with rest (MedlinePlus), often worse at the end of the day and better after sleep (NHS). Tiredness, stress, infections and certain medicines can trigger it (NHS).

  • Eyes and face: drooping eyelids (ptosis), blurred or double vision, and changes in facial expression (NINDS). See our Eyes guide for other causes of vision changes.
  • Mouth and throat: trouble chewing, slurred speech, a quiet or nasal voice, and trouble swallowing; inhaling bits of food can cause repeated chest infections (NHS).
  • Neck, arms and legs: trouble holding up the head, lifting, rising from a chair, climbing stairs or washing your hair; the arms are usually weaker than the legs (NHS).
  • Breathing: shortness of breath, particularly when lying down or after exercise (NHS).

Ocular and generalized MG

In ocular MG, weakness stays in the muscles of the eyes and eyelids; generalized MG also affects muscles elsewhere (MGFA). For most people, weakness that starts in the eyes spreads over weeks, months or years, but if only your eyes have been affected for 2 years or more, later spread is unusual (NHS).

Flares and myasthenic crisis

A flare is a period of worse weakness without needing help to breathe; in a myasthenic crisis the breathing muscles can’t move enough air and a ventilator is needed (MGFA). About 15–20% of people with MG have at least one crisis (NINDS). In a review of 127 patients’ records, infections (30%) and medicines that may worsen MG (19%) were the biggest contributors to flares (chart review, PubMed).

Medicines that can make MG worse

Many medicines have been linked to worsening MG. MGFA stresses that this doesn’t always mean you can’t take them — reports are often very rare and some drugs may be needed — but you and your doctors should weigh the risk and watch for worsening (MGFA). Never stop a prescribed medicine on your own. Examples (MGFA):

In a 2024 study at two US hospitals, the flares seen after a flagged medicine followed intravenous magnesium or intravenous labetalol (hospital study, PubMed), and pharmacists are urged to take particular care with macrolides, fluoroquinolones, beta-blockers and magnesium (review, PubMed). Tell your surgeon about MG before any operation (NHS). See our Anesthesia & Surgery Recovery and Medication Safety guides.

How it’s diagnosed

MG can be hard to diagnose when weakness is mild or limited to a few muscles (NINDS). Besides an exam, tests include:

Congenital myasthenic syndrome, a rare inherited condition, causes similar weakness through gene changes rather than the immune system (NINDS, MedlinePlus Genetics).

What to expect over time

There is no known cure, but most people with MG live to an average life expectancy (NINDS). MG usually has phases of flare-ups and improvement; remission can happen, but permanent remission is rare (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Care led by a neurologist: pyridostigmine for symptoms; steroids and immunosuppressants (azathioprine, mycophenolate, tacrolimus); FDA-approved biologics for generalized MG (complement inhibitors, FcRn blockers, inebilizumab); IVIG or plasma exchange for severe flares and crisis; thymectomy for selected patients; avoiding medicines that worsen MG. Drug, infusion and surgery costs: cost estimate being researched. Medicare Part B pays for medically necessary outpatient physical therapy; you pay 20% after the deductible. MGFA lists copay and financial-assistance programs. No cure, but most people live a normal lifespan and treatment helps most. Thymectomy improved outcomes in the MGTX trial. Biologics carry serious infection warnings; complement inhibitors have a boxed warning.
Chiropractic No role in treating MG. Possibly gentle care for neck or back pain, with your neurologist’s agreement. About $55–$100 a follow-up visit and $90–$200 for a first visit, self-pay. Only three case reports claim benefit; one report linked electrical stimulation and manipulation to a lasting flare. Weak neck muscles and steroid-thinned bones call for caution.
Acupuncture Fine needles, sometimes with moxibustion, added to standard MG medicines. About $90–$185 a private follow-up visit; community clinics about $50–$90. Reviews of mostly Chinese trials report benefit, but study quality is low. A small 2025 US pilot found it feasible and safe. Never a substitute for MG medicines.
Herbal medicine No herb or supplement is proven to treat MG. Chinese herbal formulas are being studied as add-ons. Cost estimate being researched. Low-quality trials only. Astragalus (huang qi) should be avoided in autoimmune disease per NCCIH; some herbs interact with immunosuppressants. Ask before taking magnesium in any form.
Massage therapy Gentle massage for relaxation, stiffness or aches from strained muscles. About $70–$90 a month for a membership at one national chain. We found no studies of massage for MG. Generally low-risk; keep it gentle, and avoid electrical muscle stimulation.
MBHA Wellness Coach Energy pacing, safe exercise cleared by your doctor, swallowing-friendly meals, heat and infection precautions, home safety, emergency planning, work accommodations and support groups. MBHA coaching cost estimate being researched. MGFA support groups are open to patients and caregivers. Supports — never replaces — your neurology team. Exercise programs have been well tolerated in stable MG.

Approach 1 of 6

Conventional medicine (AMA)

MG is usually managed by a neurologist, guided by international consensus recommendations last updated in 2020 (international consensus guidance). We don’t list doses here.

1. Cholinesterase inhibitors: pyridostigmine (Mestinon)

Usually the first medicine, pyridostigmine slows the breakdown of acetylcholine so signals reach the muscles better (NINDS). Its effect lasts only a few hours, so it is taken several times a day. Side effects can include stomach cramps, diarrhea, nausea and muscle twitching (NHS). There are no large randomized trials, but its benefit in observational studies is so clear that a placebo trial would be hard to justify (Cochrane review, 2014). The label warns that too much can cause a cholinergic crisis — weakness that can involve the breathing muscles and be hard to tell from a myasthenic crisis (Mestinon label).

2. Steroids and other immunosuppressants

Steroid tablets such as prednisone calm the immune attack; the dose is lowered as much as possible once symptoms are controlled, because long-term use can cause weight gain, mood swings and infections (NHS). A Cochrane review found limited evidence of significant short-term benefit over placebo (Cochrane review, 2005). Steroids can briefly worsen MG in the first two weeks (MGFA).

Other immunosuppressants — azathioprine, mycophenolate mofetil and tacrolimus — can improve strength but cause significant side effects and need careful monitoring (NINDS); they can take months to work (NHS). Rituximab, a B-cell treatment increasingly used in MG, probably reduces relapses needing rescue therapy, but its long-term effect on symptoms is uncertain (Cochrane review, 2025).

3. Newer FDA-approved biologics for generalized MG

From each medicine’s FDA-approved prescribing information:

Know the warnings.

4. IVIG and plasma exchange

Plasma exchange filters harmful antibodies from the blood; intravenous immunoglobulin (IVIG), made from donors’ antibodies, temporarily changes how the immune system works. Both are used in severe MG and last only weeks or months (NINDS), and both are part of emergency treatment for a crisis, with oxygen and, if needed, a ventilator (NHS).

The evidence: a 2025 Cochrane review of 12 trials found low-certainty evidence that IVIG may modestly help compared with placebo, probably with more headaches, and may help less than plasma exchange in the short term (Cochrane review, 2025). An older Cochrane review found no adequate randomized trials of plasma exchange, but many case series reporting short-term benefit, especially in crisis (Cochrane review, 2002).

5. Thymectomy

Surgery to remove the thymus, often through keyhole cuts, can reduce symptoms (NINDS, NHS). It aims to improve the long-term outlook, and results may take one to two years or more (MGFA); it doesn’t always help, and a thymoma is usually removed anyway (NHS).

The MGTX trial: when Cochrane reviewers looked in 2013, they found no randomized trials of thymectomy (Cochrane review, 2013). The NIH-funded MGTX trial then randomly assigned 126 adults with generalized, AChR-positive MG and no thymoma to thymectomy plus prednisone or prednisone alone. Over three years, the surgery group had less weakness, needed less prednisone, less often needed azathioprine (17% vs. 48%), and was less often hospitalized for flares (9% vs. 37%) (MGTX trial, 2016). In a five-year extension, the benefits continued, though the authors urge caution because the group was small (MGTX extension, 2019).

6. Therapy and support

A speech-language pathologist can help with voice and swallowing problems (MGFA), and assistive devices can help with mobility (NINDS).

What it costs

  • Physical therapy: Medicare Part B covers medically necessary outpatient physical therapy with no yearly limit; you pay 20% of the approved amount after the Part B deductible (Medicare.gov).
  • Medicines, infusions, plasma exchange and surgery: cost estimate being researched. MGFA lists copay-assistance and other financial help, such as independent charitable funds (MGFA).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic is a licensed health care profession; treatment typically involves hands-on therapy, often including spinal manipulation (NCCIH). It does not treat MG, which is an immune disease of the nerve–muscle junction (NINDS).

The evidence: our PubMed search found only single-patient case reports. Three describe people whose MG symptoms eased during chiropractic care (case report, PubMed, case report, PubMed, case report, PubMed); because MG naturally has periods of improvement and remission (NHS), single cases can’t show that the care caused the change. In the other direction, a 1987 report described a woman whose MG flared after weeks of chiropractic electrical stimulation, diathermy and spinal manipulation; the authors suspected the repeated electrically triggered muscle contractions (case report, PubMed).

If you see a chiropractor for neck or back pain

  • Tell your neurologist first, and tell the chiropractor you have MG and which medicines you take.
  • Serious side effects of spinal manipulation are very rare but may be more likely in people with underlying health problems; neck manipulation has been linked to rare artery tears that can cause stroke (NCCIH). MG can weaken the neck muscles (NHS), and long-term steroids can thin the bones (MGFA), so as an MBHA caution we advise gentle, low-force care and no electrical muscle stimulation.
  • New weakness, drooping eyelids, double vision or trouble swallowing are MG warning signs for your neurologist, not a spinal problem.

Cost: about $55–$100 for a self-pay follow-up visit and about $90–$200 for a first visit (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is widely used for MG in China, and several reviews have pooled the trials:

  • A 2024 review of 14 randomized trials found that adding acupuncture to standard medicine improved response rates and symptom scores, but the quality of the studies was generally low and it urged caution (meta-analysis, PubMed).
  • Another 2024 review of 11 studies (658 patients) of acupuncture and moxibustion found better overall response, but no clear difference on an ocular MG score, and signs of publication bias (meta-analysis, PubMed).
  • A 2025 US pilot trial in 24 people found twice-weekly acupuncture for 12 weeks feasible and safe, with mostly mild needle-site reactions; participants reported feeling better, and a proper efficacy trial is planned (pilot trial, PubMed).

In short: acupuncture may have a supporting role, but the evidence is weak. It should only be added to — never replace — your MG treatment, and you should not change your medicines because of it.

Safety

Relatively few complications have been reported; FDA requires needles to be sterile and single-use (NCCIH). As an MBHA caution, tell the acupuncturist you have MG, and avoid electroacupuncture unless your neurologist agrees, given the case report of MG worsening after repeated electrical muscle stimulation (case report, PubMed).

Cost: about $90–$185 for a private follow-up visit and up to about $230 for a first visit; community acupuncture about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement is proven to treat MG. Reviews of Chinese herbal medicine, used alongside standard treatment, report benefits — a 2022 review of 19 trials found moderate- to low-certainty evidence that a formula called Compound Huangqi added to standard treatment probably improves symptoms (meta-analysis, PubMed), and a 2018 review noted methodological flaws and called for more rigorous trials (meta-analysis, PubMed). These trials don’t show that herbs can replace MG medicines.

Check with your neurologist and pharmacist before taking any herb or supplement. Supplements can interact with medicines and pose risks with some medical problems or before surgery (NCCIH).

  • Astragalus (also called huang qi): NCCIH advises people with autoimmune diseases to avoid it because it might worsen them, and it may interact with immune-suppressing medicines (NCCIH).
  • Asian ginseng may worsen autoimmune disorders, and cat’s claw may interact with immunosuppressants (NCCIH).
  • Chinese herbal products have sometimes been contaminated with undeclared drugs, heavy metals or the wrong herbs (NCCIH).
  • Magnesium and quinine are on MGFA’s list of drugs that may worsen MG; the magnesium warning is about doses given into a vein (MGFA). We found no clear guidance on magnesium supplements by mouth, so as an MBHA caution, ask your neurologist before taking magnesium in any form.

Nutrition that does help

If you take steroids long term, MGFA advises getting enough calcium and vitamin D for your bones and cutting back on salt; ask your doctor how much you need (MGFA). We don’t list doses here. Herbal cost estimate being researched.

Approach 5 of 6

Massage therapy

We searched PubMed and found no studies of massage for MG. Massage won’t treat the nerve–muscle problem, but gentle massage may feel good for stiffness, stress or aches from muscles that tire easily. MG weakness worsens with activity and improves with rest (MedlinePlus), so a relaxing session at a time of day when you feel stronger may suit you best.

Safety

Cost: at one national chain, a membership with one session a month runs about $70–$90 a month (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

MGFA calls MG a “snowflake disease” because everyone’s is a little different (MGFA). An MBHA Wellness Coach can help you build daily habits around your neurologist’s plan, never instead of medical care.

Energy pacing

Plan demanding tasks, such as exercise or housework, for when you feel strongest or after your Mestinon takes effect, and save quieter tasks for when energy dips; sit rather than stand when you can (MGFA). Avoid overdoing it and get plenty of rest (NHS). See our Chronic Fatigue guide for more pacing ideas.

Safe exercise

Exercise was once discouraged in MG, but a 2026 review of eight controlled studies found that structured programs were well tolerated in stable MG and improved strength, function and daily activities (systematic review, PubMed), and another linked physical and breathing training to fewer symptoms, stressing individualized programs (meta-analysis, PubMed). MGFA suggests starting small, such as a couple of minutes on a treadmill, with low-impact options like walking, yoga and resistance bands, and building in rest (MGFA). Get your neurologist’s OK first.

Eating and swallowing

Try five or six smaller meals about an hour after your medicine, choose soft, moist foods, sit upright with your head tilted slightly forward, and rest between bites; thickeners make thin liquids safer to swallow (MGFA).

Heat, infections and vaccines

Heat can worsen MG — stay in air conditioning and keep your home from overheating (MGFA). Infections are a common trigger (NHS). Most MG specialists believe vaccines’ benefits far outweigh any small risk, but people on immune-suppressing medicines are usually advised to avoid live vaccines (MGFA) — ask your doctor before any vaccine.

Home safety and emergencies

Use grab bars, a shower chair and non-skid mats, keep walkways clear, wear a medical ID, and have someone check on you daily if you live alone (MGFA). Avoid swimming alone (NHS). See our Balance guide. A coach can help you track symptoms and put together MGFA’s emergency packet — your medicine list, emergency contacts, its wallet alert card and cautionary-drug list — plus a small hospital go-bag (MGFA). Pack your Mestinon in its original bottle, since a hospital pharmacy may not have it right away (MGFA).

Work, stress and support

Stress at work often makes MG worse. Under the Americans with Disabilities Act, people with MG may be entitled to reasonable accommodations, such as rest breaks and flexible hours (MGFA). MGFA runs virtual and in-person support groups for patients, caregivers and families (MGFA), and encourages caregivers to learn about MG, communicate, and look after themselves (MGFA). See our Anxiety and Depression guides if you are struggling. MBHA coaching cost estimate being researched.

Another approach

Pregnancy and newborn MG

If you have MG and are thinking about pregnancy, planning ahead matters. MGFA advises talking with your MG specialist and obstetrician well before trying to conceive, so treatment can be adjusted (MGFA); for example, the Uplizna label advises effective contraception (Uplizna label). Don’t stop any medicine without advice.

Transient neonatal MG

The mother’s antibodies can cross to the baby, causing neonatal myasthenia (MedlinePlus). It affects about 10–20% of babies born to mothers with MG; signs range from mild feeding difficulties to life-threatening breathing weakness, and it can interfere with breastfeeding (systematic review, PubMed). It is temporary: symptoms usually go away within two to three months (NINDS), and most babies do well with observation alone (systematic review, PubMed), and it does not mean the child will have MG later (MGFA). Make sure your baby’s care team knows you have MG. An MBHA Pregnancy guide is on the way.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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