Neuromuscular neurology · UK
A myasthenia gravis clinic, by a neuromuscular specialist.
A dedicated private MG service in London: AChR, MuSK and LRP4 serology, single-fibre EMG, thymectomy per MGTX, IVIg and PLEX, and access to eculizumab, ravulizumab, efgartigimod, rozanolixizumab and zilucoplan for refractory disease.
Indicative pricing
What a private MG clinic costs in the UK.
Indicative ranges across UK units.
In short
A first neuromuscular consult in London: £350 to £550, workup within two weeks.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial neuromuscular consult (45 to 60 min) | £350 to £550 | 45 to 60 min | Same visit |
| AChR-Ab, MuSK-Ab and LRP4-Ab serology panel | £280 to £520 | 15 min draw | 7 to 10 days |
| Single-fibre EMG (SFEMG) or RNS | £650 to £1,400 | 45 to 90 min | Same visit |
| CT chest for thymoma screening | £450 to £850 | 20 min | 48 hours |
| IVIg 2g/kg course (5 day infusion) | £4,500 to £9,000 | 5 days | Booked within a week |
| Plasma exchange (PLEX), five sessions | £8,000 to £14,000 | 2 weeks | Booked within a week |
| Thymectomy (VATS or transsternal, per MGTX) | £14,000 to £24,000 | Day-case to 3 nights | 2 to 4 weeks |
| Eculizumab (Soliris) refractory AChR programme | £150,000+ per year | Fortnightly | Funding review |
Prices vary by hospital, by consultant, by whether IVIg or PLEX runs as day-case or inpatient, and by biologic funding route.
The journey
From referral to biologic, what happens, in order.
One team from first message to long-term monitoring, including infusions and thymectomy planning where indicated.
- 04
On the day
Clinic assessment
A 45 to 60 minute consult: MGFA classification, Osserman staging where relevant, review of triggers and drugs, and a shared treatment plan.
- 05
On the day
Treatment started or adjusted
Pyridostigmine dose optimisation, prednisolone with slow titration, and steroid-sparing IST chosen for your subtype and comorbidities.
- 06
On the day
Home the same day
Written plan, safety-net advice on myasthenic crisis, and a 24-hour contact for deterioration between clinic visits.
- 07
After
Infusions, monitoring and biologics
IVIg or PLEX arranged if you need bridging. Eculizumab, ravulizumab, efgartigimod, rozanolixizumab or zilucoplan discussed for refractory disease.
When it helps
The common presentations, and the ones that need A&E.
MG ranges from purely ocular (MGFA I) through generalised (II to IV) to intubated crisis (V). Each has its own pathway.
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Fatigable ptosis and diplopia
Drooping eyelids and double vision that worsen with sustained upgaze or through the day. The ice pack test is a bedside pointer for ptosis.
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Bulbar weakness
Slurred speech, nasal voice, choking on liquids, difficulty chewing. The MuSK-positive subgroup often presents this way, with respiratory involvement.
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Generalised limb weakness
Proximal fatigable weakness in shoulders and hips. Worse after repetition and towards evening. The pattern that turns MGFA class I into class II or III.
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Respiratory decompensation
Breathlessness on exertion, orthopnoea, forced vital capacity below 20 ml/kg. Myasthenic crisis needs ITU and IVIg or PLEX, not clinic titration.
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AChR-positive generalised MG, under 65
The MGTX trial group where thymectomy adds clear steroid-sparing and functional benefit alongside prednisolone.
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Thymoma on CT chest
Around 10 to 15 per cent of AChR-positive patients. Thymectomy is indicated whatever the age or MGFA class.
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Refractory MG despite two steroid-sparing agents
Where azathioprine, mycophenolate, methotrexate, ciclosporin or tacrolimus have failed. Complement (eculizumab, ravulizumab, zilucoplan) or FcRn (efgartigimod, rozanolixizumab) are on the table.
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Red flag: myasthenic crisis
Rapidly worsening bulbar or respiratory weakness. This is an A&E and ITU situation, not a private booking. Call 999 and go straight in.
Treatment options
Symptomatic, immunosuppressive, surgical and biologic.
Modern MG treatment stacks four layers. Where you sit depends on serology, MGFA class, response so far, and life plans.
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Symptomatic: pyridostigmine
The workhorse acetylcholinesterase inhibitor. Titrated 30 to 60 mg every four to six hours, watching for GI cramps, secretions and cholinergic effects.
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Corticosteroids: prednisolone slow titration
Started low and increased slowly to avoid an early steroid dip. Often bridged with IVIg or PLEX in more severe disease.
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Steroid-sparing IST
Azathioprine, mycophenolate mofetil, methotrexate, ciclosporin or tacrolimus. Choice depends on subtype, comorbidities, fertility plans and TPMT status.
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IVIg 2g/kg for crisis or bridging
Intravenous immunoglobulin over two to five days. Rapid onset within a week, effect lasts four to six weeks. Renal function and thrombosis risk reviewed first.
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Plasma exchange (PLEX)
Five sessions over roughly two weeks. Fastest onset of any therapy. Vascular access, calcium and clotting all managed on the unit.
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Thymectomy per MGTX
VATS or transsternal. Indicated in AChR-positive generalised MG under 65, and for any thymoma. Adds steroid-sparing benefit over years, not weeks.
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Complement inhibitors
Eculizumab (Soliris) and ravulizumab (Ultomiris) block C5. Zilucoplan (Zilbrysq) is a daily subcutaneous option. All licensed for refractory AChR-positive MG.
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FcRn inhibitors
Efgartigimod (Vyvgart, licensed 2024) and rozanolixizumab (Rystiggo) reduce pathogenic IgG. Cyclical dosing, useful when disease waxes and wanes.
Safety and monitoring
The things worth planning, honestly.
MG is treatable, but the drug avoidance list, IST monitoring and crisis planning matter more than any single prescription.
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Drug avoidance list
Aminoglycosides, fluoroquinolones, telithromycin, intravenous magnesium and neuromuscular blockers can precipitate crisis. Beta blockers, macrolides and some statins are used cautiously.
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Steroid side effects
Weight, mood, glucose, bone density and cataracts. Bone protection, PPI cover and glycaemic monitoring are set up from day one on prednisolone.
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IST monitoring
FBC, LFTs and U&Es every two weeks initially, then monthly. TPMT before azathioprine, drug levels for ciclosporin and tacrolimus.
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Vaccination and infection risk
Meningococcal vaccination before eculizumab or ravulizumab. Annual influenza, COVID and pneumococcal cover for all patients on immunosuppression.
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Myasthenic vs cholinergic crisis
Sudden worsening of weakness can be either too little or too much acetylcholine. Never guess at home. FVC, bulbar function and cholinergic signs guide the call.
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Pregnancy planning
Mycophenolate and methotrexate are teratogenic. Azathioprine, ciclosporin, prednisolone and IVIg are the usual antenatal choices. This needs planning before you conceive.
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Anaesthesia and surgery
Any planned surgery is flagged to anaesthetics in advance. Suxamethonium and non-depolarising blockers are used with care and reversal is planned.
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Fatigue and driving
Diplopia and fatigable weakness affect fitness to drive. DVLA notification is required for generalised MG.
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Red flags after clinic
Worsening swallowing, breathlessness, orthopnoea, weak cough. Call the 24-hour contact or go to A&E the same day.
Reading your clinic letter
Your MG letter in four parts. Read the last one first.
Whichever consultant sees you, the letter that follows keeps to the same shape.
- 01 Header
Subtype, serology and MGFA class
AChR-positive, MuSK-positive, LRP4-positive or seronegative. MGFA class I ocular through class V intubated. This drives every downstream decision.
- 02 Technique
Neurophysiology and imaging
SFEMG jitter and blocking, RNS decrement percentages, ice pack test result, and CT chest findings on the thymus.
- 03 Findings
Triggers and drug review
Recent infections, missed doses, new prescriptions from the avoidance list, and any procedures on the horizon that need pre-planning.
- 04 Impression
Plan and safety net
Read this first: pyridostigmine dose, steroid and IST plan, whether IVIg, PLEX, thymectomy or a biologic is on the pathway, and the 24-hour contact.
Recognised by major UK insurers
Cover for MG varies by insurer. Consults, workup and IVIg or PLEX are usually funded when medically indicated. Biologics need a funding review.
Frequently asked
Everything patients commonly ask about MG.
Quick answers on diagnosis, thymectomy, biologics and drug safety.
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What is myasthenia gravis?
MG is an autoimmune disease where antibodies against the postsynaptic acetylcholine receptor (AChR), or against MuSK or LRP4, block neuromuscular transmission. The result is fluctuating fatigable weakness of ocular, bulbar, limb or respiratory muscles. It is treatable, and most patients do well with a well-run plan.
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How is MG diagnosed?
By clinical pattern (fatigable weakness, ptosis, diplopia), serology (AChR-Ab, then MuSK-Ab and LRP4-Ab if seronegative), and neurophysiology (single-fibre EMG for jitter and blocking, or repetitive nerve stimulation for decrement). The bedside ice pack test supports ocular MG. Every AChR-positive patient has a CT chest to exclude thymoma.
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What does private treatment cost?
A first consult is roughly £350 to £550. Serology and neurophysiology add £1,000 to £2,000. An IVIg 2g/kg course is £4,500 to £9,000. PLEX runs £8,000 to £14,000. Thymectomy is £14,000 to £24,000. Eculizumab is over £150,000 per year and needs a funding route.
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Should I have a thymectomy?
The MGTX trial supports thymectomy in AChR-positive generalised MG under 65, alongside prednisolone. Any thymoma is a separate, absolute indication. Video-assisted (VATS) is preferred where anatomy allows, otherwise transsternal. MuSK-positive patients are usually not thymectomised.
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When are biologics like eculizumab or efgartigimod used?
For refractory generalised MG despite two steroid-sparing agents and either IVIg or PLEX. Eculizumab and ravulizumab (complement C5), and zilucoplan (subcutaneous C5), are for AChR-positive disease. Efgartigimod and rozanolixizumab (FcRn inhibitors) reduce pathogenic IgG and suit patients with waxing-and-waning disease.
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Which drugs should I avoid?
Aminoglycosides, fluoroquinolones, telithromycin, intravenous magnesium and neuromuscular blockers can precipitate a crisis. Beta blockers, macrolides, some statins and certain antimalarials are used cautiously. Always tell every prescriber that you have MG, and carry a card.
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