MSEC

Welcome to the MSEC

The Myasthenia Gravis Symptom Evaluation Checklist (MSEC) was developed to asses the effects of treatment and monitor the general well-being of an individual with myasthenia gravis over time.

The MSEC consists of three sections. Sections I and II are scored and combined for an overall score. The items in Section III are not scored and are for use only as additional information.

The MSEC is not a diagnostic checklist. It provides a score to be used for comparison at a later date. Basically, the lower the score, the lesser the individual's overall symptom severity.

Please choose the option that best describes your current symptoms. Be as honest as possible.

In terms of the word "daily" that means if you were to do this activity daily, would you have symptoms? For example:  Some MG patients are not physically able to shower daily. But every time they shower, their symptoms are severe. That person would choose "Daily-severe" because if they were able to perform the activity daily, their symptoms would be severe.

After you click "Submit" a screen will load with your answers and score (please ignore the portion that says "Correct Answer", there are no correct or incorrect answers. That is just an artifact of the software we are using. A copy of your answers and score will also be sent automatically to the email address you provided.

This form is for informational purposes only and is not intended to diagnose or treat any patient.

Copyright 2016 Debbie Norman director of Women with Myasthenia Gravis ALL RIGHTS RESERVED

 

NameEmail
SECTION I: SYMPTOMS

weakness during showering
weakness after showering
shortness of breath due to showering
difficulty chewing
difficulty swallowing
difficulty with hand-writing
hand weakness
hand clumsiness
double vision/blurry vision
ptosis/eyelid drooping
difficulty speaking
difficulty speaking at length/speech endurance
word-slurring
problems getting the word you want to say
overall muscle weakness
overall endurance problems
facial drooping (non-eye)
difficulty holding up head/neck weakness
overall end-of-day weakness
shortness of breath
diaphragm weakness
difficulty standing
difficulty standing for long periods
difficulty walking short distances
difficulty walking long distances
difficulty bending for extended time
difficulty squatting
arm fatigue during daily activities
overall fatigue problems
leg weakness
brain fog/cognitive issues
pain (This would be pain directly related to, or caused by, your MG. Not other injuries, etc.)
digestive issues
problems dropping things
difficulty smiling
heat intolerance/sensitivity
humidity intolerance/sensitivity
cold intolerance/sensitivity
balance problems
falling
almost falling
tremors
leaking urine/incontinence
frequent urination
urinary retention/problems fully eliminating
fecal/bowel incontinence (The inability to fully control your bowel movements, causing stool to leak unexpectedly from your rectum. It can range from occasional leakage of a small quantity of stool while passing gas, to a complete loss of bowel control.)
SECTION II: ACCOMMODATIONS/ASSISTIVE DEVICES

For the following questions please choose the option that best represents your frequency of use/need.

For example: You may not go out everyday. But if you did, would you need to use your handicapped parking pass every time? If so, choose Daily.

handicapped parking pass
cane/walking stick
walker/rollator
wheelchair - long distances (example: needing a wheelchair to go out shopping, or other activities that would require long distance walking)
wheelchair - short distances (example: needing a wheelchair around your home or to walk around your yard)
mobility scooter - If you need one, but do not own one because you cannot get approved for one or afford one, then please choose the option for how often you would need to use it if you had it.
neck support
shower seat/chair - We know that some MG patients are not able to shower daily. But please answer this question as if you were. If you were showering daily, would you need this assistive device?
assistance showering and/or washing hair (meaning the aid of another individual to help you perform all or part of this task) - We know that some MG patients are not able to shower daily. But please answer this question as if you were. If you were showering daily, would you need this assistance?
bi-pap
c-pap
at home ventilation/non-invasive ventilation
cooling vest
adjustable bed
lift chair
electric recliner (meaning it changes the seating position electrically and does not use muscle power to operate it)
eye patch
cough assist machine
home oxygen
oxygen concentrator
service dog (How often do you use a dog that actually provides physical services? Examples would be: a dog that brings you items that you need, gives you support to lean on, helps you raise yourself from a seated position, etc.)
therapy/emotional service dog (How often do you use a dog, or other animal, that provides therapy/emotional services?)
wedge/raised pillow for bed
body pillow for body support in bed
SECTION III: ADDITIONAL INFORMATION

If you have questions about how to do a Single Breath Count, or haven't had a reminder on how to do one recently please view this short demonstration given by Alice White-Kaminski.

Your Single Breath Count on a Good Day (aim for testing on your best day)
Enter that count in the field below.
Have you had any other illnesses since completing the previous MSEC? If yes, please describe:
(If this is your first MSEC, just answer N/A.)
Have you had any hospitalizations since completing the previous MSEC? If yes, please describe:
(If this is your first MSEC, just answer N/A.)
Please list the medications and treatments (i.e. IVIG, etc.) you are currently taking for your MG, in the format of type, dosage, frequency.
(for Example: mestinon, 60mg, 4 times per day)
Please list all other medications (non-MG) you are currently taking in the format of type, dosage, frequency. Please include both prescription and over-the-counter medications. (For example: Aspirin, 100 mg, a few times a week as needed) If you have been on additional medication for illness, etc. please include the above information and duration of use.
Please list any supplements you are currently taking, in the format of type, dosage, frequency.
If any of the above medications, treatments, or supplements are a change or have changed in dosage, etc. from your previous MSEC, please explain or answer "no change".
If there is anything else you feel is not covered in this form that you would like to include for your own records, or for your practitioner, please mention it here.