Objective:

To characterize fatigue in patients with myasthenia gravis, identify other comorbid factors that contribute to it and propose routine screening recommendations.

Background:

Fatigue is a frequent complaint in patients with myasthenia gravis. However, it is non-specific and often associated with other medical conditions. Some of the most frequent causes of fatigue can be indirectly related to myasthenia and its treatment or another simultaneous condition. With this study, the goal is to guide providers on weather to routinely screen for comorbid, potentially treatable causes of fatigue in MG patients.  

Design/Methods:

Patients were recruited from VCU Neurology clinics. Inclusion criteria were adults with a confirmed diagnosis of myasthenia gravis from positive antibodies or electrodiagnostic testing. Enrolled patients had a battery of serum laboratory tests collected that included B12, MMA, CBC, TSH and testosterone levels in men. They also filled out questionnaires including PSQI, Epworth Sleepiness Scale and Neurology QoL surveys for fatigue, depression and anxiety. Patients and their primary neurologists were notified of any abnormal lab results and their participation in the study did not have any influence on management of their disease.

Results:

28 patients were enrolled in this study, completed the questionnaires and had laboratory studies collected. 19 patients were female and 9 were male. 68% of patients had an MGFA post-intervention status of MM3. 61% of patients had a fatigue severity scale >36 and 68%  scored >50 on the fatigue portion on the QOL questionnaire. 43% of patients had abnormal laboratory results, mostly either anemia or vitamin D deficiency. Regarding sleep, 75% had a PSQI score >5. For psychiatric comorbidities, 46% scored >50 on the anxiety and 50% scored >50 on the depression portion. 

Conclusions:

The results of this study suggest that fatigue in patients with myasthenia gravis is multifactorial and routine screening for other causes is warranted.