1. The MG Neuro Exam
What’s it all about?

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

3. 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

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

5. 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

6. 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)

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

8. Eye & Eyelid Movements Facial Movements

9. Respiratory
Neck movements
Arms
Legs

10. Speech, Swallowing & Breathing Patterns

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

12. MGFA classification
Hand out

13. MGFA Post Intervention Status
Handout

14. 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