Assessment of fatigue and autonomic dysfunction in myasthenia gravis – case report

Klaudia Kwiatkowska, Martyna Lamtych, Karolina Kubiak, Ewelina Litwa, Nataliia Badiuk


Introduction: Myasthenia gravis (MG) is an autoimmune disease in which neuromuscular conduction disorders occur. The reason is the loss of acetylcholine receptors and the presence of antibodies directed against these receptors. The most characteristic symptoms of myasthenia gravis are: tenderness and weakness of striated muscles, which intensify particularly during exercise and in the evening. Non-motor symptoms such as: fatigue, disorders of the autonomic nervous system can be asymptomatic, and in a significant proportion of cases significantly affect the quality of life. A full understanding of non-motors symptoms is needed to treat patients with MG. The aim of the study was to present the characteristics of non-motor symptoms on the example of a patient with myasthenia gravis.
Material and methods: A 50-year-old woman who had been suffering from myasthenia gravis for 23 years was examined. Chalder Fatigue Scale, Epworth Sleepiness Scale, Orthostatic Grading Scale were used to evaluate non-motor symptoms. The orthostatic reaction was tested using the tilt test.
Results: The most frequently reported non-motors symptoms in the patient were: chronic fatigue, sleep disturbances and cardiovascular symptoms (orthostatic intolerance, weakness).
Conclusions: Myasthenia gravis is characterized by a large variability of symptoms. An important part of the clinical picture are non-motor symptoms that can affect the functioning of patients in everyday life.


myasthenia gravis; non-motor symptoms; fatigue

Full Text:



Kostera-Pruszczyk A: Postępowanie terapeutyczne w miastenii. Polski Przegląd Neurologiczny 2013; 9 (1): 11–15.

Hamed SA: Comorbid nervous system manifestations and disorders with myasthenia gravis: Evidences and possible mechanisms. Journal of Neurology and Neuroscience. 2012: 3: 1:3.

Brola W, Ziomek M, Czernicki J: Fatigue syndrome in chronic neurological disorders. Neurologia i Neurochirurgia Polska 2007; 41 (4): 340–349.

Alekseeva TM, Gavrilov YV, Kreis OA, Valko PO, Weber KP, ·Valko Y: Fatigue in patients with myasthenia gravis. Journal of Neurology 2018; 265: 2312–2321.

Jörg J. Diagnostyka autonomicznego układu nerwowego i zaburzeń snu. Urban & Partner, Wrocław 2001.

Tong O, Delfiner L, Herskovitz S: Pain, Headache, and Other Non-motor Symptoms in Myasthenia Gravis. Curr. Pain Headache Rep. 2018; 22: 39.

Jackson C: The Chalder Fatigue Scale (CFQ 11). Occupational Medicine. 2015; 65 (1): 86.

Johns MW: A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep 1991: 14 (6): 540-545.

Zalewski P, Słomiński K, Klawe J, Tafil-Klawe M: Functional assessment of autonomic nervous system by using the Task Force Monitor® system. Acta Bio-Optica Inf. Med. Inż. Biomed. 2008: 14 (3): 228-234.

Zalewski P, Klawe J, Pawlak J, Tafil-Klawe M, Bitner A, Lewandowski A: Changes of the heart muscle contractility in healthy persons after single whole-body cryostimulation procedure. Acta Bio-Optica Inf. Med. Inż. Biomed. 2011; 17 (4): 257-261.

Schrezenmaier C, Gehrking JA, Hines SM, Low PA, Benrud-Larson LM, Sandroni P: Evaluation of orthostatic hypotension: relationship of a new self-report instrument to laboratory-based measures. Mayo Clin Proc. 2005; 80 (3): 330-334.

Nikolić A, Perić S, Nisić T, Popović S, Ilić M, Rakocević Stojanović V, Lavrnić D: The presence of dysautonomia in different subgroups of myasthenia gravis patients. J Neurol. 2014; 261: 2119–2127.

Elsais A, Wyller VB, Håvard Loge J, Kerty E: Fatigue in myasthenia gravis: is it more than muscular weakness? BMC Neurol. 2013; 13: 132.

Hoffmann S, Ramm J, Grittner U, Kohler S, Siedler J, Meisel A: Fatigue in myasthenia gravis: risk factors and impact on quality of life. Brain Behav. 2016; 6 (10): e00538.

Alekseeva TM, Gavrilov YV,  Kreis OA,  Valko PO,  Weber KP,  Valko Y: Fatigue in patients with myasthenia gravis. Journal of Neurology. 2018; 265: 2312–2321.

Paul RH, Cohen RA, Goldstein JM, Gilchrist JM: Fatigue and its impact on patients with myasthenia gravis. Muscle Nerve. 2000; 23 (9): 1402-1406.



  • There are currently no refbacks.

Copyright (c) 2019 © The Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

POL-index 2011 - 2014

BASE 2011 - 2014

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

Find a library that holds this journal:

Journal Language(s): English 

PBN Poland



Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2 Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase


Universal Impact Factor 1.78 for year 2012. (

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ)

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski