It is recognized that the type of antibodies present in the disease determines it's clinical behavior.7 Myasthenia patients with antibodies against acetylcholine receptors (AChR) have more of a variable presentation which includes weakness in the limbs more than the bulbar muscles involvement, marked ptosis, and associated thymoma in 80% of the cases.7 Whereas, myasthenia patients who have antibodies against MuSk, 80% of them show bulbar impairment,4 including dysphagia, dysphonia, chewing problems, slurred speech and tongue weakness/atrophy. The gene discussed is MUSK; the disease is thymoma.