Letter re: International consensus guidance for management of myasthenia gravis: Executive summary

In the international consensus for managing myasthenia gravis (MG), minimal manifestation status (MMS) or better was recommended as the treatment goal.1 MMS refers to no symptoms of functional limitations from MG, but some weakness on examination of some muscles.2 However, there are no criteria to detect the minimal weakness that is clinically important and biologically plausible. Only one study tried to link MMS and MG-specific quality of life scores.3 Moreover, the dose of pyridostigmine is an important factor that should be considered in attributing symptoms or functional limitations to MG. What is the optimal cutoff on measurements of weakness and pyridostigmine dose in the definition of MMS?