Myasthenia gravis (MG) makes your muscles weak because it impacts how your nerves and muscles work together. It can cause a variety of symptoms including:
- Muscle weakness
- Fatigue
- Droopy eyelids (ptosis)
- Double vision
- Difficulty swallowing or speaking
You might notice your muscles get weaker throughout the day, so your symptoms can worsen, too.
MG is a chronic condition, which means you need ongoing care from your health care provider and team. There’s no cure, but treatments can help you make your symptoms better and improve your quality of life.
Symptoms of MG are different for everybody. They’re often hard to track because they can vary every day. They’re often triggered by things like stress, heat, infections, and lack of sleep. But doctors don’t know when you might have a flare-up, or if you’ll go into remission. This makes tracking your symptoms important. One way to track symptoms is with the MG Activities of Daily Living scale, or the MG-ADL.
What Is the MG-ADL Scale?
The MG Activities of Daily Living scale (MG-ADL) lets you or your doctor measure and track your MG symptoms using a simple form. It helps your doctor assess how the condition is affecting your life. It includes eight questions, and you score yourself from 0 to 3 on the following activities:
- Talking
- Swallowing
- Chewing
- Breathing
- Brushing your hair
- Getting up from a chair
- Double vision
- Eyelid droop
Zero means normal and 3 means you’re having severe symptoms.
For instance, when you’re grading how your MG affects your talking, you’d give yourself a 0 if your speech is normal; a 1 if you have intermittent slurring or nasal speech; a 2 if you have constant slurring or nasal speech, but others can understand you; and a 3 if your speech is difficult for others to understand.
You repeat this for all activities on the scale and add up your numbers to find your results. Your score will fall between 0 and 24. Typically, the higher your score, the more severe your symptoms are, and the greater the limitations on your daily living. Remember that everyone's score is different. How your symptoms compare to someone else’s depends on a lot of factors.
For example, you could score a 3 out of 24, which is low. But if you gave yourself a 3 on vision because you’re seeing double, you might have trouble driving compared to someone who scored a 3 because they have difficulty getting out of their chair.
A score of 0 or 1 is considered minimal symptom expression (MSE), which means you have few or no symptoms of MG.
The MG-ADL Scale score is often used with the Myasthenia Gravis Composite scale (MGC). Both evaluate how severe your symptoms are, but there are differences between the two.
The MG-ADL scale is usually self-reported, meaning you rate your symptoms based on the 0 to 3 scale. The MGC score, however, is determined by an examiner based on scores from other tests that evaluate your double vision, eye closure, neck extension, shoulder abduction, and hip flexion. Those tests are the Quantitative Myasthenia Gravis-Revised (QMG-R) and Myasthenia Gravis Manual Muscle Testing (MG-MMT). Your examiner will use the scores of those tests, plus your MG-ADL score, to get your MGC score. They determine what changes have occurred as a result of MG.
How Often Should I Fill Out the MG-ADL Scale?
Your doctor or health care provider will let you know when you should fill out the MG-ADL Scale and how often. Once you’ve got a baseline score, they may want you to complete the scale a few times a year to see how well your treatment plan is working. Or they may ask you to fill it out daily or monthly to see if your symptoms change over time.
Why You Need to Track Your MG Symptoms
It's important to track your MG symptoms because it helps you manage your condition. It also helps your health care team provide you with the best treatments available.
Catching flare-ups early
Tracking your symptoms allows you and your care team to have a baseline — meaning you know what’s normal for you. This will help you recognize symptoms when they’re out-of-the ordinary so you can let your doctor know right away, and before they become full blown crises.
Knowing your triggers
By now you know your MG symptoms fluctuate and you might know what causes your worst flare-ups. Common triggers include:
- Stress
- Fatigue
- Infections
- Hormonal changes
- Extreme temperatures
- Certain medications
Why the MG-ADL Scale Helps Your Care Team
While there are treatment options available, your doctor may have a difficult time knowing if they’re working. Tracking your symptoms helps your care team know when to make adjustments to your treatments so they can improve your daily life.
Using the MG-ADL scale works. A 2022 review of 48 publications and 35 clinical trials found the MG-ADL is a good tool for measuring MG symptoms, specifically for how they respond to treatment. The same review found that even a 2‐point improvement on an MG-ADL is a sign of “improved clinical status” if you have mild to moderate MG.
New treatments for MG continue to become available. Using the MG-ADL Scale to track your symptoms helps your doctor and care team decide which drugs are best for you.
Show Sources
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SOURCES:
Canadian Agency for Drugs and Technologies in Health: “Description and Appraisal of Outcome Measures - Clinical Review Report: Eculizumab (Soliris).”
Muscle and Nerve: “Utilization of MG‐ADL in myasthenia gravis clinical research and care.”
Neurology and Therapy: “Understanding the Symptom Burden and Impact of Myasthenia Gravis from the Patient’s Perspective: A Qualitative Study.”
StatPearls: “Myasthenia Gravis.”
Myasthenia Gravis Foundation of America “MG Emergencies.”
Conquer Myasthenia Gravis “MG Activities of Daily Living (MG-ADL) Scale.”
CDC: “About Chronic Diseases.”
Cleveland Clinic: “Myasthenia Gravis: What It Is, Causes, Symptoms & Treatment,” “Myasthenia Gravis Outcomes.”
Johns Hopkins Medicine: “Myasthenia Gravis.”
