What are Difference between Myasthenia Gravis and Multiple Sclerosis?

Learn key differences between Myasthenia Gravis and Multiple Sclerosis: causes, symptoms, diagnosis, and treatment options explained for global patients.

What are Difference between Myasthenia Gravis and Multiple Sclerosis?

  • Category

    General

  • Published By

    GetWellGo Team

  • Updated on

    21-Apr-2025

Myasthenia gravis and multiple sclerosis comparison

Myasthenia gravis vs multiple sclerosis:
 

Feature

Myasthenia gravis

Multiple sclerosis

Type of Disease

Autoimmune neuromuscular disorder

Autoimmune demyelinating disorder of the central nervous system

Main Problem

Impaired communication between nerves and muscles

Damage to myelin sheath around nerve fibers in brain and spinal cord

Cause

Antibodies attack acetylcholine receptors at the neuromuscular junction

Immune system attacks myelin in CNS (brain, spinal cord, optic nerves)

Key Symptoms

Muscle weakness that worsens with activity (fatigue), drooping eyelids (ptosis), double vision (diplopia), difficulty swallowing or breathing

Numbness, weakness, balance problems, vision issues, cognitive changes, muscle spasticity

Pattern

Fluctuating weakness (worse with use, better with rest)

Relapsing-remitting or progressive decline

Areas Affected

Voluntary (skeletal) muscles

CNS (brain, spinal cord, optic nerves)

Onset

Often sudden and fluctuates daily

Can be gradual, with periods of worsening and partial recovery

Age of Onset

Any age, often young adults or middle-aged women

Young adults (20–40 years most common)

Diagnosis

Antibody blood tests (AChR, MuSK), EMG, Tensilon test

MRI brain/spinal cord, lumbar puncture (CSF analysis), evoked potentials

Treatment

Acetylcholinesterase inhibitors (like pyridostigmine), immunosuppressants, plasmapheresis, IVIG

Steroids, disease-modifying therapies (like interferons, monoclonal antibodies), symptomatic treatments

Prognosis

Variable; many manage symptoms well with treatment
 

Variable; can be mild to disabling depending on disease course

 

Neurological difference MS and myasthenia gravis

Feature

Multiple Sclerosis

Myasthenia Gravis

Location of Damage

Central Nervous System (CNS) — brain, spinal cord, optic nerves

Neuromuscular Junction — where nerve endings meet muscles

Problem Type

Damage to the myelin sheath that insulates nerve fibers → slows or blocks nerve signals inside the CNS

Blockage of signal transmission from nerve to muscle due to antibodies attacking receptors

Effect on Nerves

Nerve fibers themselves become scarred ("sclerosis") and miscommunicate internally

Nerves are normal; the problem is at the connection to muscles (external to CNS)

Type of Symptoms

Sensory loss (numbness, tingling), weakness, visual disturbances, cognitive issues, spasticity

Fluctuating muscle weakness, especially with repeated use (e.g., drooping eyelids, trouble chewing, breathing weakness)

Nerve Signal

Slowed or distorted inside the brain and spinal cord

Fails at the junction where the nerve meets the muscle

 

Is myasthenia gravis a type of MS?

No, myasthenia gravis (MG) is not a form of multiple sclerosis (MS) — they are two totally different diseases.
Here's a simple way to think about it:
 

  • MS is a central nervous system disease — it harms the brain and spinal cord itself.
  • MG is a neuromuscular junction disease — it harms the link between muscles and nerves, but the brain and spinal cord are fine.

Both are autoimmune disorders (where your immune system attacks your own body), but they attack different targets and create different types of issues.

How to tell MS from myasthenia gravis?

 

Multiple Sclerosis

Myasthenia Gravis

Main Symptom

Sensory changes (numbness, tingling), weakness, vision loss, balance problems, spastic muscles

Muscle weakness that gets worse with use — especially eyes (drooping eyelids, double vision), face, swallowing, breathing

Fatigue Pattern

General tiredness and nerve damage over time

Muscle fatigue that worsens with repeated activity, improves with rest

Areas Most Affected

Brain, spinal cord, optic nerves

Muscles controlled by voluntary movement (especially eyes, face, throat, limbs)

Onset

Often gradual, sometimes sudden attack (relapse)

Sudden muscle weakness, often noticeable after physical activity

Unique Clues

Vision loss in one eye (optic neuritis), electric shock feeling with neck movement (Lhermitte's sign)

Eyelid drooping (ptosis) and double vision that worsens throughout the day

Tests to Diagnose

MRI brain/spinal cord, lumbar puncture (CSF), evoked potentials

Blood test for AChR or MuSK antibodies, EMG (repetitive nerve stimulation), Tensilon test

Response to Treatment

Steroids and MS disease-modifying therapies

Rapid improvement after acetylcholinesterase inhibitors (like pyridostigmine)

Early signs of MS and myasthenia gravis

Early Signs of MS:

  • Blurred vision, double vision, or vision loss (especially in one eye — optic neuritis)
  • Weakness in limbs, clumsiness, stiffness, spasms
  • Numbness, tingling (pins and needles), "electric shock" feeling when bending neck
  • Heavy tiredness, even after resting (due to nerve damage)
  • Dizziness, poor balance, trouble walking
  • Slurred speech (due to nerve damage) in later stages
  • Urgency, frequency, constipation (due to nerve damage)

Early Signs of MG:

  • Drooping eyelids (ptosis), double vision that worsens throughout the day
  • Muscle weakness that gets worse with activity and improves with rest (especially face, eyes, neck, arms)
  • No sensory loss — sensation is normal
  • Muscle-specific fatigue — muscles get tired fast with use
  • Usually normal unless muscles needed for posture are weak
  • Early speech and swallowing difficulty, especially after talking/eating for a while
  • Rare in MG (not a primary symptom)

Can you have MS and myasthenia gravis together?

Yes, it's possible to have MS and Myasthenia Gravis (MG) at the same time, but it's extremely uncommon.

Here's the easy explanation:

  • Both MS and MG are autoimmune disorders, which mean your immune system attacks your own body by mistake.
  • Having one autoimmune condition slightly raises your risk of developing another one — so it can happen that a person with MS might develop MG (or vice versa).
  • When an individual has both MS and MG, physicians refer to it as an "overlap syndrome" or "coexisting autoimmune disorders."

Myasthenia gravis Diagnosis vs MS

MG Diagnosis:

  • Detecting a problem at the neuromuscular junction (where nerve meets muscle)
  • Check for antibodies: AChR (acetylcholine receptor) antibodies or MuSK antibodies
  • Tensilon (edrophonium) test — temporary improvement in muscle strength after injection
  • EMG (electromyography) with repetitive nerve stimulation — shows muscle response weakening
  • Chest CT or MRI (to check for a thymoma — tumor in the thymus gland)
  • Ice pack test for droopy eyelid (ptosis improves after cooling)
  • Can often be diagnosed quickly with blood tests and simple bedside tests

MS Diagnosis:

  • Detecting damage inside the central nervous system (brain, spinal cord)
  • Sometimes check for immune markers, but not a primary test
  • Evoked potentials — measure slowed nerve signals in brain/spinal cord
  • MRI of brain and spine — look for plaques/lesions ("white spots" showing myelin damage)
  • Lumbar puncture (spinal tap) — look for oligoclonal bands in cerebrospinal fluid (sign of MS)
  • Diagnosis can take longer — needs MRI, spinal tap, clinical follow-up to confirm

Multiple sclerosis or myasthenia gravis which is worse?

  • MS can be worse long-term because it can permanently damage the brain and spinal cord.
  • MG is more dangerous short-term if it causes a breathing crisis, but with good treatment, most people live well.

Difference in treatment MS vs myasthenia gravis

 

MS

MG

Main Treatment Goal

Slow disease progression, reduce relapses, manage symptoms

Improve muscle strength, prevent myasthenic crises

Medications for Core Disease

Disease-Modifying Therapies (DMTs):
- Interferons (e.g., Avonex, Rebif)
- Monoclonal antibodies (e.g., ocrelizumab, natalizumab)
- Oral drugs (e.g., fingolimod, dimethyl fumarate)

Acetylcholinesterase Inhibitors:
- Pyridostigmine (Mestinon) to improve communication between nerves and muscles

Steroids Use

Used during relapses to reduce inflammation (e.g., IV methylprednisolone)

Used during severe weakness or myasthenic crisis

Immunosuppresants

Sometimes used (e.g., azathioprine, methotrexate) if MS is aggressive

Commonly used (e.g., prednisone, azathioprine, mycophenolate mofetil) to lower antibody attack

Emergency Treatments

High-dose steroids for MS flare-ups

Plasmapheresis (plasma exchange) or IVIG (intravenous immunoglobulin) for myasthenic crisis

Surgery

Not usually needed

Thymectomy (removal of the thymus gland) — helps some MG patients

Lifestyle Management

Physical therapy, occupational therapy, managing fatigue and temperature sensitivity

Energy conservation techniques, physical therapy focused on maintaining muscle strength without overfatiguing

Prognosis with Treatment

Can slow progression significantly; some live almost normal lives

Good symptom control for most patients; crisis can be prevented with treatment