When should I consider referring a patient with myasthenia gravis to a specialist for further management?

Consider referring a patient with myasthenia gravis to a specialist for further management if:

• There is evidence of progressive or worsening muscle weakness affecting limb, bulbar (speech or swallowing), or respiratory function.
• Symptoms are rapidly progressive, especially if respiratory compromise or swallowing difficulties develop.
• There is diagnostic uncertainty or need for specialist confirmation and management planning.
• Initial diagnosis has not been established by a specialist neurologist.
• There is a need for ongoing specialist input for treatment optimization, including immunosuppressive therapy or management of crisis situations.

Referral should be made without delay when these features are present to ensure timely specialist assessment and integrated care.

This approach aligns with NICE recommendations for neurological conditions, which advise urgent referral for rapidly progressive neuromuscular weakness and specialist involvement in diagnosis and management of neuromuscular disorders.

NICE NG127,NICE NG42