Introduction and aims We identified previously-audited shortfalls in myasthenia gravis diagnostic and management practice, notably in ensuring appropriate bone protection and making sure that patients were followed up in prompt time. We aimed to reaudit practice at The Walton Centre and identify adherence to ABN guidelines.

Methods Patients investigated for suspected myasthenia presenting October 2017 to September 2018 who were subsequently managed at the Walton Centre.

Results 43 patients identified. Anti-AChR at first appointment: 42/43 (97%) Serum anti-MuSK if anti-AChR is negative: 9/10 (90%) MR brain for ocular MG if serology and neurophysiology negative: 1/1 (100%) Thymus imaging for all patients: 38/41 (93%). Neurophysiology if serology negative: 7/7 (100%) First follow-up within six weeks: 38/41 (44%). Second follow-up within 12 weeks: 22/40 (55%) Generalised MG admitted unless symptoms mild: 9/10 (90%) Pyridostigmine started at the time of diagnosis: 35/36 (97%) Glucocorticoids started if no remission on pyridostigmine: 22/22 (100%) Bone protection if on glucocorticoids: 19/21 (90%)

Conclusion We found that adherence had improved regarding bone protection when on steroids, but follow-up times remained a problem. Additionally, anti-MUSK and EMG were largely used when indicated, but also often unnecessarily used in the presence of positive AChR antibodies.