The face of myasthenia gravis

Abstract

Myasthenia gravis (MG) is characterized by fluctuating weakness and fatigability of skeletal muscles. In most patients, extraocular and bulbar muscles are affected first, leading to diplopia, ptosis, and weakness of facial muscles.1 We recorded the faces of 38 healthy controls and 52 patients with MG while performing a standardized set of facial expressions. These images were averaged using Python version 3.8.0. This resulted in highly similar faces with no recognizable individual features. The only discernible differences are typical clinical hallmarks of the disease: ptosis and generalized facial weakness around the eyes and mouth resulting in less vivid facial expression (figure).