Pronounced Ptosis in Myasthenia Gravis-A New Bedside Clinical Sign

We report three cases of myasthenia gravis in whom the asymmetrical ptosis at presentation became more pronounced with the described bedside technique. Pronounced ptosis could be elicited by making the patient speak continuously for up to 2 minutes. Pauses for breathing and natural blinking were allowed. The sign is best elicited in newly diagnosed and treatment-naive patients. The loss of compensation for ptosis by frontalis muscle due to speech-induced fatigue may be responsible for the observed effect. Patients' symptoms abated on treatment with acetylcholine esterase inhibitors, steroids, and steroid-sparing agents.