Myasthenia Gravis–Induced Fears of Diagnosed Patients During the Pandemic

Patients with myasthenia gravis (MG) had higher reported anxiety-inducing fears during the COVID-19 pandemic compared with the general population. Their immunosuppressive medications had the potential to make them more susceptible to acute respiratory infections, like COVID-19, according to a recent study published in Brain and Behavior.¹

MG is an antibody-mediated autoimmune disease affecting neuromuscular junctions of the skeletal muscle, resulting in fatigued muscle weakness, which can be life-threatening if respiratory muscles are affected. The study, conducted in Germany, observed an increase in patients with MG reporting fears of risk for their own health compared with the general population. Although MG is not an immunosuppressant disease, long-term use of the immunosuppressive therapies used to treat it increases patients’ risk of infection. Similar fears were observed in patients with autoimmune diseases like multiple sclerosis and rheumatoid arthritis, suggesting that fear related to the risk of one’s health may be associated with the body’s ability to protect itself against diseases, like the SARS-CoV-2 infection, or lack thereof.

Other studies have also investigated if SARS-CoV infection could have induced MG in certain patients. Some scientists believe that the new onset of MG after COVID-19 may be explained by the infection's ability to mimic the molecular breakdown of self-tolerance mechanisms, often preceding or exacerbating MG. It is likely that prior research such as this gives justifiable cause to patients with MG for fears of risks to their health during the pandemic.^2,3

COVID-19–Related Fears of Patients With MG

The longitudinal observational study was conducted via online questionnaire and split into 3 survey periods (SPs) between May 2020 and February 2022. The survey assessed sociodemographic information, MG-related questions (ie, disease duration and antibody status), current MG-specific medication, therapies, and COVID-associated anxiety. Specific questions related to fears asked if patients' anxieties were influenced by MG and if said fears of COVID-19 infection were due to MG itself or increased risk due to MG-specific medication.¹

The first 2 SPs—May 28, 2020, to September 1, 2020, and November 29, 2020, to February 20, 2021—used the same survey, as they were released before COVID-19 vaccination became widely available in Germany on December 27, 2020, whereas the third SP (November 30, 2021, to February 2, 2022) included questions about COVID-19 vaccination and whether survey participants received it or not, the type of vaccine, and any vaccine-associated adverse events.

Of patients with MG, 322 participated in SP1, 295 in SP2, and 392 in SP3, for an overall study population of 1009. However, only 648 patients completed a survey, with 401 patients participating at least once, 133 patients twice, and 114 who participated in all 3 SPs. Their mean age was 53.5 years; 65.8% of patients were female and 34.2% were male. Most patients were on immunosuppressive therapy (69.9%).

The percentage of patients who knew someone with COVID-19 increased from 34.8% in SP1 to 87.0% in SP3. The percentage of patients with MG with COVID-19 infections increased from 0.0% in SP1 to 8.4% in SP3. On the contrary, the percentage of hospitalizations of patients with MG and a COVID-19 infection remained relatively low (0.0% in SP1 to 1.8% in SP3), which the study authors attributed to the strict precautionary measures patients with MG may have taken—social distancing, wearing protective equipment, and avoiding travel.

Overall, the most prevalent pandemic-related fear was the fear of negative consequences for one’s own health in case of an infection (83.9%), followed by fear for the health of others (75.6%) and fear of an infection in general (61.2%). The majority of patients also stated that their COVID-19–related fears were influenced by the diagnosis of MG (75.1%) and MG-related fears concerning the exacerbation of myasthenic symptoms in case of infection (overall 66.6%).

Study Limitations

This study has several limitations. Its observational design and convenience sampling may have limited causal inference and generalizability, particularly for older patients, while reliance on online, self-reported data could have introduced potential selection and response biases. Cross-country comparisons are further complicated by variability in pandemic conditions and differences in how psychopathological symptoms were defined and assessed.

“Our findings indicate that anxiety related to COVID-19 was more prevalent among MG patients compared to the general population during the pandemic and mainly concerned one’s own health,” the study authors concluded. “This makes an ongoing psychological and emotional impact of the COVID-19 pandemic among MG patients likely and highlights the need for a screening for depression and anxiety in this population in clinical practice.”

References

1. Beckmann J, Petzold A, Betzler F, et al. Anxiety in myasthenia gravis patients throughout the COVID-19 pandemic—prevalence, risk factors, and association with vaccination status. Brain Behav. 2025;15(9):e70878. doi:10.1002/brb3.70878

2. Shaw M. Case investigated of patient with possible COVID-19–induced myasthenia gravis. AJMC^®. August 2, 2023. Accessed September 25, 2025. https://www.ajmc.com/view/case-investigated-of-patient-with-possible-covid-19-induced-myasthenia-gravis

3. Tereshko Y, Gigli GL, Pez S, De Pellegrin A, Valente M. New-onset myasthenia gravis after SARS-CoV-2 infection: case report and literature review. J Neurol. 2023;270(2):601-609. doi:10.1007/s00415-022-11472-6