myasthenia gravis

Demonstrated fatigable weakness

Record affected movements, activity dependence and recovery separately from subjective fatigue.

1. Which movements weaken during sustained or repeated use, and what recovery follows rest? measurement
2. Which observations were examined directly, reported by the person or inferred from earlier records? provenance

Supporting and conflicting tests

Retain original antibody and electrophysiology reports, test conditions and specialist interpretations.

1. What were the antibody and electrophysiological results, methods, dates and laboratory reference limits? provenance
2. How did the diagnosing clinician reconcile negative, equivocal or discordant results? definition

Alternative explanations

Keep competing explanations explicit until their relevance has been assessed.

1. What evidence distinguishes this presentation from Lambert-Eaton syndrome, congenital myasthenic syndromes, botulism, myopathy or focal ocular disease? boundary
2. Which unresolved alternative requires additional specialist assessment before accepting MG? action

Phenotype assignment

Record current and historical weakness distribution alongside the exact antibody testing scope.

1. Is weakness currently ocular-only or generalized, and has extraocular weakness ever been documented? boundary
2. Which antibody targets and assays support the assigned phenotype, and which remain untested? provenance
3. What definition of seronegative is being used in this assessment? definition

Thymic findings

Link chest imaging and pathology without inferring a thymic diagnosis from the MG label.

1. What imaging or pathology establishes the thymic assessment, and when was it performed? provenance
2. Does the finding require a linked thymoma or surgical assessment? action

Onset mechanism

Record onset age, exposure timing and evidence relevant to autoimmune, inherited or passively transferred mechanisms.

1. What is the earliest supported symptom onset relative to medication exposure and relevant family or maternal history? provenance
2. Does the evidence support autoimmune MG or a linked congenital or transient neonatal disorder? boundary

Activity limitations

Record which visual, speaking, chewing, swallowing, breathing and limb activities are affected.

1. Which MG-ADL items or directly described activities are impaired, and by how much? measurement
2. When was the assessment made relative to exertion, rest and medication dosing? provenance
3. Which limitations may instead reflect another condition or a treatment adverse effect? boundary

Course assessment

Preserve baseline, comparable follow-up observations and the definition behind each clinician-assigned outcome.

1. Compared with which dated baseline has weakness, functional burden or muscle involvement changed? measurement
2. What criteria and treatment status support a label such as exacerbation, minimal manifestations or remission? definition
3. Does the change meet the person's agreed threshold for clinical reassessment? action

Bulbar safety

Record swallowing, secretion handling, speech and cough changes with clinical assessments.

1. Is there new choking, difficulty handling secretions, weak cough or rapidly worsening speech or swallowing? measurement
2. What swallowing or airway assessment and current feeding instructions have clinicians documented? provenance

Ventilatory status

Retain respiratory symptoms, serial measurements, measurement reliability and assistance requirements.

1. How have breathing symptoms, vital capacity and inspiratory pressure changed, with what measurement limitations? measurement
2. Is ventilatory assistance required, and what cause and urgency have clinicians assigned? definition

Crisis response context

Record prior crises, current clinician assessment and the emergency handover information needed for action.

1. Which current signs require immediate emergency assessment under the applicable care pathway? action
2. What prior crisis, ventilation and rescue-treatment history should accompany escalation? provenance
3. Who receives the escalation, and how is receipt or clinical review confirmed? action

Intervention response

Link each intervention to its intended outcome, actual exposure, follow-up and adverse effects.

1. What MG problem was each intervention intended to address, and what treatment was actually received? provenance
2. What functional or clinical change followed, over what interval and with which concurrent interventions? measurement
3. What evidence separates inadequate response from intolerance, interrupted access or incomplete exposure? boundary

Medication and exposure cautions

Check new exposures against current MG cautions while preserving the distinction between an association and an absolute prohibition. [MGFA cautionary drugs](https://myasthenia.org/understanding-mg/learn-more-about-mg-treatments/mg-brochures/cautionary-drugs/)

1. Which medicines, supplements or recent exposure changes require MG-specific clinician or pharmacist review? action
2. What evidence, exposure timing and alternative explanations support suspected medication-related worsening? provenance

Clinical action authority

Represent the prerequisites and responsible clinician for MG treatment changes and coordination around surgery, pregnancy or infection.

1. Which antibody phenotype, thymic finding, comorbidity or life circumstance affects the proposed decision? boundary
2. Which current guideline, product information or local pathway governs eligibility and monitoring? provenance
3. What may the agent summarize or flag, and which decision requires the treating clinician's authorization? action