Inheritance mostly autosomal recessive but autosomal dominant in a few. Diverse neuromuscular junction gene mutations in pre and postsynaptic proteins particularly choline acetylase, Collagen Q, AChR, MuSK, DOK7 and others. Not always clinically evident in early life and older onset genetic disorders can be misdiagnosed as autoimmune MG. If suspected, refer to Rodriguez Cruz et al., 2018 for details. This evidence concerns the gene CHAT and hereditary disease.