Always evaluate:
Tidal volume
Forced Vital capacity (normal is >25cc/kg in<unk> 
FEV
Negative inspiratory force (NIF) (normal is -80 to -100 and greater than +20 respiratory support indicated)
Ability to handle secretions
ACh-R antibody testing: first-line investigation. Indication for thymectomy if < 45 years.
MuSK antibody testing: for patients negative for ACh-R antibodies
Thyroid function
Neurophysiology: Repetitive nerve stimulation is the initial test; if negative, consider single-fibre electromyography.
MR scan of brain: Patients with negative serology and neurophysiology, and symptoms compatible with ocular<unk>  may have structural brain disease.
Thymus scanning: All patients with suspected<unk> , irrespective of distribution (ocular/generalised) or serology (seropositive/negative), should undergo thymus imaging. The modality (CT or MRI) should be decided locally.
Edrophonium/Tensilon test
MuSK antibody testing: for patients negative for ACh-R antibodies
Pyridostigmine and neostigmine primarily used for symptomatic relief but does not alter course of crisis. Consider avoiding pyridostigmine/neostigmine in ICU ventilated patients, as these may increase secretions. Continued use of these meds also prevents assessment of other treatment modalities and can increase muscle weakness if used in excess
Pyridostigmine: Titrate up to find the lowest effective dose
Initially 30<unk>  four times daily for 2–4 days
Then 60<unk>  (1 tablet) four times daily for 5 days and experiment with timing
Then increase to 90<unk>  four times daily over 1 week if required.
If patient's usual dose has been missed the next dose is usually doubled
IV route: 1/30th of the PO dose (2-3mg) by slow IV infusion
Neostigmine
0.5mg IV
Initially 30<unk>  four times daily for 2–4 days
Then 60<unk>  (1 tablet) four times daily for 5 days and experiment with timing
Then increase to 90<unk>  four times daily over 1 week if required.
If patient's usual dose has been missed the next dose is usually doubled
IV route: 1/30th of the PO dose (2-3mg) by slow IV infusion
0.5mg IV
Prednisolone: If symptomatic despite Pyridostigmine. Monitor diabetes mellitus.
Ocular<unk> 
Start 5<unk>  on alternate days for three doses and increase by 5<unk>  every three doses until symptoms improve.
The maximum dose is 50<unk>  on alternate days or 0.75<unk> /kg/alternate day
Generalised<unk> 
Start 10<unk>  on alternate days for three doses and increase by 10<unk>  every three doses until symptoms improve.
Maximum dose is 100<unk>  alternate days or 1.5<unk> /kg
Start 5<unk>  on alternate days for three doses and increase by 5<unk>  every three doses until symptoms improve.
The maximum dose is 50<unk>  on alternate days or 0.75<unk> /kg/alternate day
Start 10<unk>  on alternate days for three doses and increase by 10<unk>  every three doses until symptoms improve.
Maximum dose is 100<unk>  alternate days or 1.5<unk> /kg
Plasmapheresis
Effect lasts 15-20 days
IVIG
0.4 g/kg/die for 5 days
Effect lasts 30-45 days
In<unk>  Crisis :
Acetylcholinesterase inhibitors are discontinued to avoid excessive bronchial secretions
Intubation
If possible avoid depolarizing AND non-depolarizing agents
If patient requires paralysis use non-depolarizing agent at smaller dose
If must use depolarizing agents, will need higher doses
IVIG and plasmapheresis
If possible avoid depolarizing AND non-depolarizing agents
If patient requires paralysis use non-depolarizing agent at smaller dose
If must use depolarizing agents, will need higher doses
Myasthenia gravis
Antibiotics 
Polymyositis
Steroids
Lambert-Eaton myasthenic syndrome
Anticonvulsants 
Tick paralysis
Psychotropics 