Myasthenia (Latin: myasthenia gravis, MG) is an autoimmune disease that affects the neuromuscular junction, leading to pathological muscle fatigue. The main symptom of the disease is muscle fatigue, which becomes more pronounced after exertion and may be especially noticeable later in the day. The disease may affect either facial muscles or all skeletal muscles of the body. In recent years, the prevalence and incidence of myasthenia have significantly increased, prompting greater attention toward identifying factors that exacerbate symptoms and minimizing their impact. Pregnancy is one such factor – as symptoms of myasthenia may worsen during pregnancy, particularly in the first trimester and/or postpartum, regardless of the overall severity of the disease. Symptom exacerbation may also be triggered by certain medications, such as antibiotics (e.g., azithromycin, aminoglycosides, fluoroquinolones). Cardiovascular drugs, such as beta-blockers, may likewise have a detrimental effect. The use of magnesium supplements is also not recommended for patients with myasthenia, as they can disrupt impulse transmission at the neuromuscular junction. Immunotherapy using immune checkpoint inhibitors in oncology can also induce exacerbations of myasthenia. It is important to note that botulinum toxin, used in aesthetic procedures, can also lead to muscle weakness. Many other factors may trigger symptom worsening as well, including an elevated body temperature, depression, respiratory infections, and insomnia. Thus, pregnancy, medications, heat, thyroid disorders, depression, infections, and insomnia – all these factors must be assessed and, wherever possible, controlled in patients with myasthenia so that to ensure an improved quality of life and a milder disease course. This article reviews literature data on factors exacerbating myasthenia.
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