Engstrom, John W · Seminars in neurology · 2004 · DOI
This paper helps doctors tell the difference between myasthenia gravis (MG) and other conditions that look similar. MG causes muscle weakness that comes and goes, especially in the eyes and face. The authors review many other diseases—including neurological problems, infections, and other conditions—that can be mistaken for MG but are actually something else.
This paper is relevant to ME/CFS because it clarifies an important diagnostic distinction: chronic fatigue syndrome and ME/CFS are rarely, if ever, manifestations of myasthenia gravis, despite overlapping presentations of fluctuating weakness and fatigue. Understanding this differential is crucial for ensuring ME/CFS patients receive appropriate diagnosis and care rather than being misdiagnosed with a neuromuscular junction disorder.
This review does not establish causal mechanisms underlying ME/CFS or myasthenia gravis, nor does it provide quantitative data on prevalence rates of MG misdiagnosis in ME/CFS populations. The article is a clinical review rather than an original research study, so it relies on expert opinion and existing literature rather than primary data analysis.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Engstrom, John W (2004). Myasthenia gravis: diagnostic mimics.. Seminars in neurology. https://doi.org/10.1055/s-2004-830903
BibTeX
@article{mecfsatlas-engstrom-2004-myasthenia-gravis,
author = {Engstrom, John W},
title = {Myasthenia gravis: diagnostic mimics.},
journal = {Seminars in neurology},
year = {2004},
doi = {10.1055/s-2004-830903},
note = {PubMed: 15257510},
url = {https://www.mecfsatlas.com/evidence/engstrom-2004-myasthenia-gravis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/engstrom-2004-myasthenia-gravis
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