title: Dysfunctional chemosensation in myasthenia gravis: a systematic review.
abstract: OBJECTIVE
  Myasthenia gravis has traditionally been viewed as a disorder that solely affects the neuromuscular junction within the peripheral nervous system. However, there is now evidence that the cholinergic dysfunction of this disorder may be more widespread than previously believed. This article provides a systematic review of the studies that examined smell and taste function in myasthenia gravis.
  
  
  METHODS
  We analyzed studies that reported chemosensory function alterations in patients with myasthenia gravis. PubMed, MEDLINE, Web of Science, EMBASE, and SciELO, searched to identify articles published from January 1950 through December 2012, were supplemented by relevant articles. The following information was identified from each article: the number of patients, number of controls (if any), clinical stage of patients, neurological involvement, serological state, taste or smell involvement, chemosensory test used, and country of publication.
  
  
  RESULTS
  Ten studies reporting smell and taste function and dysfunction in patients with myasthenia gravis were identified, most of which were case reports commenting on apparent abnormalities in the taste system. The sole empirical study that investigated taste function, however, was negative, suggesting that some reports of taste loss may reflect olfactory loss. One study clearly documented olfactory dysfunction in patients with myasthenia gravis, dysfunction most likely attributable to altered central nervous system cholinergic function.
  
  
  CONCLUSIONS
  Chemosensory dysfunction has been reported in a number of patients with myasthenia gravis. Given the close association between complaints of taste dysfunction and loss of flavor sensations secondary to olfactory system damage, quantitative testing should be used to accurately assess the nature and degree of the dysfunction present in this debilitating disorder.
authors: Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. feleones@gmail.com
authors: Fidias E
authors: FE
authors: Leon-Sarmiento
authors: Daniel S
authors: DS
authors: Leon-Ariza
authors: Richard L
authors: RL
authors: Doty
mesh_terms: D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications*; D000857:Olfaction Disorders / Q000453:epidemiology* / Q000209:etiology*; D013651:Taste Disorders / Q000453:epidemiology* / Q000209:etiology*