The aim of this work is to study the effect of Ramadan fasting on patients with Myasthenia Gravis (MG) and to propose some treatment options for those who are willing to fast in the absence of formal recommendations.  

Ramadan is the ninth month of the Islamic lunar calendar when approximately 1.8 billion Muslims worldwide practice intermittent fasting from dusk till dawn. Patients with MG face major challenges during this month due to alterations in drug regimens and their day-long fasting.

This is a prospective study conducted in the main tertiary neurology center in Kuwait. We evaluated MG patients one month before, during and after Ramadan in the summer season of 2019. Severity of weakness was classified according to Myasthenia Gravis Foundation of America (MGFA) classification and the dose of pyridostigmine was adjusted for those willing to fast.

We evaluated 141 MG patients; 71 (50.4%) males and 70 (49.6%) females. Only 113 (80.1%) were willing to fast the holy month. The commonest reasons for not fasting were dose frequency in 23 (16.3%) patients and disease severity in 16 (11.3%). The days of fasting ranged from (4 – 29) days with a mean of 27.6 ± 4.3. Outcome was stable in 91(80.5%), worsened in 17 (15.0%) and 5 patients (4.4%) improved. Outcome was correlated to the different clinical parameters.

This is the first study in literature describing the effect of Ramadan fasting on patients with MG. A stable outcome was seen with ocular MG, lower pyridostigmine dose and frequency before Ramadan, less number of immunosuppressants and who had grade (IIb) severity or less before fasting. Those who worsened in Ramadan returned to pre-Ramadan status during the follow up period.