The MG Neuro Exam What’s it all about?

There is no exam without a history What is your biggest concern today? ( eg weakness, speech, swallowing, eyelid droop, double vision..other)

What we need to know Location Quality or character of weakness Quantity or severity of weakness Timing (onset, duration, frequency) Setting What makes “it” worse, better Other factors

The Exam Muscle Grading System: MRC scale (0-5) Manual Muscle Testing (MMT) (4-0)

MRC SCALE Grade 5 = normal power Grade 4 = active movement against gravity and resistance Grade 3 = active movement against gravity Grade 2 = active movement with gravity eliminated Grade 1 = flicker or trace of muscle movement Grade 0 = no muscle movement

Manual Muscle testing (MMT) 0 = normal strength (0% weak) 1 = mildly weak (25% weak) 2 = moderately weak (50% weak) 3 = severely weak (75% weak) 4 = no movement (100% weak)

Cranio Bulbar Strength Face, eyelids, eye movements Tongue movements, jaw opening/closure Speech, swallowing

Eye & Eyelid Movements Facial Movements

Respiratory Neck movements Arms Legs

Speech, Swallowing & Breathing Patterns

Quantified Myasthenia Gravis Testing Handout With all testing need to know When was last cholinesterase inhibitor (ChI) ieMestinon, Pyridostigmine?

MGFA classification Hand out

MGFA Post Intervention Status Handout

Summary The MG neuro exam includes multiple assessment tools and strategies Comparison of examination results over time in an individual assists the health care team to determine the best treatment plan with the least side effects