Question: I am a 72 year old female living in Auckland, New Zealand. I lost most of my sense of taste about 10 years ago, following a bout of pneumonia About 6 - 7 years ago, the left hand side of my upper lip went numb overnight. This numbness gradually spread over the left hand side of my face, including inside my mouth and the lower half of my nose. Two years ago I realised I was stumbling over a few words. This was the beginning of dysarthria, which has progressed and has affected my life profoundly. Speech therapy is helping somewhat. I have seen 4 neurologists and have had the following tests done:
MRI x 3
CT scan
Nerve conductor tests (Twice)
Lumbar puncture
All tests have come back clear. None of the neurologists have been able to make a diagnosis. I have no difficulty swallowing, but it takes me a long time to masticate food to the point where I am comfortable swallowing it. My tongue doesn't seem to be able to move food round my mouth the way it should do. My ability to suck is limited, with the unexpected consequence that I have reduced my cigarette intake from 20 per day to 3, as there is just no point! I intend to give up completely. My general health is excellent...I have a little asthma, but nothing else. I have had very little down time with illness over the years. My only hospitalisation in 30+ years was for carotid artery surgery about 12 years ago. I have also had minor surgery to correct ptosis. I eat and sleep well, live independently and am well supported b y family and friends. Would you or any of the doctors online be able to diagnose this neurological condition, which is obviously progressive? I understand that motor neurone disease has virtually been ruled out


I meant to include this in the initial information. The way my spine has grown at the back of my neck has meant that a slight curve has pushed my head forward a little. About 3 weeks ago, my daughter observed that this was more pronounced than usual. A couple of days later, I had a slight ache at the back of my neck which I had not had before. That went, but as I became more tired toward night, my head started to droop to the left hand side. It became something of an effort to hold it up. This has continued. It does not happen during the day unless I have had my head down doing something for a long time. It does not happen when I am sitting. Since this has happened, I have found it marginally more difficult to breathe at times, but again, this is no problem when I am sitting or lying down. I saw my neurologist today, who says the muscles at the back of the neck are weaker, and she is ordering more nerve conduction tests. I have recently had a neck xray, also a chest xray, neither of which have thrown up any problem.

Dear Dr XXXXXXX
Many thanks for your response. I have been reading everything I can find on myasthenia gravis, and found much I can relate to. No neurologist I have seen to date has raised this as a possibility, and I am wondering why.
I know that with the nerve conductor tests that have been carried out to date, there were no concerns. I am due to have some more tests done on my neck as a result of the recent changes to my head and neck which I referred to in my email to you. This is the first time muscle weakness has been suggested.
Just a couple of questions: When nerve conductor tests are carried out as a component of diagnosis, is it standard practice to do the repetitive nerve stimulation test you referred to in your reply? Or is that a completely separate test for myasthenia gravis?

Dear Dr XXXXXXX
I do get tired but maybe not as much as appears to be normal for those with MG.
If my GP/neurologist prescribes Pridostigmine, what difference(s) will I notice and how soon? Does it impact on breathing problems, as my breathing has gotten marginally worse since I experienced that head droop about 3 weeks ago.
What would need to be established for removing the thymus to be considered as the best option?
If my lungs have been affected by a neurological condition, including MG, will exercise such as walking, exercise regimes, Pilates etc, help to build breathing capacity? I look forward to your response.

You have been most helpful. I will give this information to my neurologist, and request an assessment for Myasthenia Gravis.
One final question: if the diagnosis is formalised through an assessment and the medication you recommend is prescribed, can I also expect an improvement in my dysarthria, and would there be any change to the numbness in the left hand side of my face?
Many thanks. I appreciate your help
Kind regards
XXXX