Journal of Neurology

, Volume 265, Issue 10, pp 2312–2321 | Cite as

Fatigue in patients with myasthenia gravis

  • T. M. Alekseeva
  • Y. V. Gavrilov
  • O. A. Kreis
  • P. O. Valko
  • K. P. Weber
  • Y. ValkoEmail author
Original Communication



The subjective feeling of fatigue in myasthenia gravis (MG) is poorly elucidated, in part because it is often confounded with the objective sign of muscle fatigability. Another reason is the paucity of validated fatigue questionnaires in MG.


We applied the 9-item Fatigue Severity Scale (FSS) and the 40-item Fatigue Impact Scale (FIS) to 73 MG patients and 230 age- and sex-matched control subjects. We ascertained levels of education, marital status, and comorbidities such as depression, sleepiness, sleep times and sleep debt. Disease severity was graded according to the Myasthenia Gravis Foundation of America (MGFA) classification.


All fatigue scores, with the exception of the cognitive FIS subscale, were higher in MG patients than controls. In MG, the prevalence of fatigue (defined by FSS scores ≥ 4.0) was 70%. Multiple regression analyses revealed several independent associates of fatigue, including depression (all fatigue scales), MGFA stage (FSS, physical FIS), female sex (cognitive and psychosocial FIS), and sleep debt (physical FIS).


Fatigue in MG is highly prevalent, mainly physical, and influenced by depressive symptoms, disease severity, female sex and sleep debt. Cognitive fatigue in MG may not be a direct disease manifestation, but secondary to depression. The FSS and FIS represent reliable and validated tools, appropriate to discern meaningful clinical aspects of fatigue in MG. Clinical recognition of the complexity of fatigue may foster individualized treatment approaches for affected MG patients.


Fatigue Impact Scale Fatigue Severity Scale Russian Myasthenia gravis 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard

The authors declare that the work documented in this manuscript has been carried out in accordance with ethical standards.

Supplementary material

415_2018_8995_MOESM1_ESM.pdf (9 kb)
Supplementary material 1 (PDF 10 KB)
415_2018_8995_MOESM2_ESM.pdf (239 kb)
Supplementary material 2 (PDF 239 KB)
415_2018_8995_MOESM3_ESM.pdf (104 kb)
Supplementary material 3 (PDF 104 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology and PsychiatryAlmazov National Medical Research CentreSt. PetersburgRussia
  2. 2.Department of NeurologyNorth-Western State Medical UniversitySt. PetersburgRussia
  3. 3.Department of General Pathology and Pathological PhysiologyInstitute of Experimental MedicineSt. PetersburgRussia
  4. 4.Department of Neurology, University Hospital Zurich, Clinical Neuroscience CenterUniversity of ZurichZurichSwitzerland
  5. 5.Department of Ophthalmology, University Hospital ZurichUniversity of ZurichZurichSwitzerland

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