This study includes clinical and laboratory studies of patients with Myathenia gravis at Sohag Neurology outpatient clinic of pediatric department

All patients in this study were subjected to the followings:

(A) Clinical history focusing on: Sociodemographic data: age, gender , residence,and degree of consanguinity. Full neurodevelopmental history: neurological evaluation Family history. Mode of delivery

(B) Thorough clinical examination: General examination including general look, vital signs and anthropometric measurements.

Scale system include gross motor function and muscle power(Quantitative Myasthenia Gravis Scale) [36] detailed neurological examination including motor ,sensory and reflexes. (C) Investigations:

1. Electrophysiological testing:

   EMG : is especially useful in diagnosis of seronegative MG and congenital myasthenic syndromes.

   NCS: including repetitive nerve stimulation test (r NST)

2. laboratory studies: Serology. Detection of antibodies to the AChR supports the diagnosis of JMG. In young children where AChR antibodies are negative this can lead to difficulty in differentiating from CMS.

   Thyroid function tests :

3. Imaging:

   CT chest: Although thymoma in children is rare, the thymus must be imaged once JMG has been diagnosed.

4. molecular studies (when possible).

Inclusion Criteria:

• All patients from 1 month to 16 years confirmed diagnosis of myasthenia gravis by neurological and laboratory data.

Care giver accept to participate in the study.

Exclusion Criteria:

• Failure to obtain informed consent. Other neurological and neuromuscular disorders. Age above 16 years.

Patients:

Patients diagnosed with myasthenia gravis at the pediatric out patient clinic by clinical charactristics ,nerve study and laboratory data will be elligable for the study.