neurology

Myasthenia Gravis Activities of Daily Living (MG-ADL) Scale

Patient-reported outcome measure assessing myasthenia gravis symptom severity across 8 functional domains. Validated tool for monitoring treatment response and disease progression.

Talking*

Chewing*

Swallowing*

Breathing*

Impairment of ability to brush teeth or comb hair*

Impairment of ability to arise from a chair*

Double vision*

Eyelid droop*

Score interpretation

Minimal Impairment 0–2

MG-ADL 0-2 -- minimal functional impairment from myasthenia gravis

→ Optimise current treatment; avoid precipitants (aminoglycosides, fluoroquinolones, beta-blockers, phenytoin, magnesium); regular neurology follow-up every 3-6 months; annual PFT (FVC); thymoma screening with chest CT at diagnosis; ensure adequate acetylcholinesterase inhibitor dosing (pyridostigmine); note baseline MG-ADL for future comparison.

Mild Impairment 3–5

MG-ADL 3-5 -- mild-moderate functional impairment

→ Review immunosuppressive therapy -- consider adding or optimising azathioprine (2-3 mg/kg/day) or mycophenolate; pyridostigmine dose optimisation; IVIG or plasma exchange for rapid improvement if needed; neurology review within 4-6 weeks; monitor FVC; consider thymectomy if thymoma or AChR antibody-positive generalised MG (MGTX trial data).

Moderate Impairment 6–9

MG-ADL 6-9 -- moderate functional impairment requiring treatment escalation

→ Escalate immunotherapy: IVIG 2 g/kg over 2-5 days or plasma exchange (5 exchanges over 10-14 days); consider rituximab for refractory MuSK-positive MG; eculizumab if AChR-positive refractory; efgartigimod or rozanolixizumab for AChR/MuSK-positive; monitor bulbar and respiratory function daily; hospital admission if FVC < 50% predicted or rapid deterioration; respiratory physician review.

Severe Impairment -- Myasthenic Crisis Risk 10–24

MG-ADL >= 10 -- severe impairment; myasthenic crisis risk

→ Urgent assessment of airway and respiratory function; FVC < 20 mL/kg or bulbar failure = intubation; ICU referral; plasma exchange preferred in crisis (faster than IVIG); withhold pyridostigmine during crisis (cholinergic crisis concern); neurology and respiratory medicine liaison; monitor electrolytes (PE causes hypocalcaemia); long-term: consider complement inhibitors (eculizumab) or FcRn antagonists (efgartigimod) for prevention of further crises.

Interpretation bands for the MG-ADL. Apply clinical judgement and local guidance.

References

Wolfe GI et al. Myasthenia Gravis Activities of Daily Living profile. Neurology. 1999;52(7):1487-1489.
NICE NG217. Myasthenia gravis: treatment algorithm and specialist referral criteria. 2022.

Curated clinical cross-links plus same-class fallbacks.

Calculators

MGFA Clinical Classification for Myasthenia Gravis · Neuromuscular

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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