Myasthenia gravis and return to flying status.

Introduction: Myasthenia gravis (MG) is a common primary disorder of neuromuscular transmission. Although MG was once a fatal disease, today treatment with immunomodulating agents and cholinomimetic medications with good supportive care have improved the prognosis and the ability of patients to adapt to their workplaces, including the flight environment.

Cases: The diagnosis of MG in two aircrew members illustrates the range of severity for MG from isolated ocular symptoms to relentlessly progressive generalized disease, as well as the unpredictability of the disease and difficulty in treatment. Nevertheless, both patients were returned to limited flying status.

Discussion: MG presents the potential for subtle progression with resulting effects on flight performance. In addition to the disease itself, flight surgeons must also consider problems related to treatment and its side effects. Progression and exacerbations of MG can develop during the course of the disease, requiring careful adjustments to treatment regimens. Taking all these factors into consideration, including the unpredictability of this disease, pilots with apparently stabilized MG should nevertheless be assigned only to duties during which the patient would be able to maintain and use his flying capabilities without risking the mission, himself, and other crewmembers.