Myasthenia gravis is a comparatively rare disease and is especially so when associated with an ophthalmoplegia. Its chief feature is a generalized weakness of the muscles with a susceptibility to their speedy exhaustion and a rapid return to their previous condition after a brief interval of rest. Either normal functioning or artificial stimulation will produce the characteristic muscular enfeeblement. There is no wasting, no reaction of degeneration.
While myasthenia is usually general, it may affect especially the lips, the palate, the pharynx, the muscles of mastication and those of the eyeball; in fact, it was the bulbar weakness which first attracted attention and gave rise to the name, asthenic bulbar paralysis.
The cases I am about to describe illustrate the two phases of the disease, the one purely bulbar, the other with ophthalmoplegia and associated bulbar and general muscular weakness.
—Mr. H. was referred to me
RIGGS CE. MYASTHENIA GRAVIS. JAMA. 1906;XLVII(24):1969–1972. doi:10.1001/jama.1906.25210240003001a
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