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(2) Rise in intracellular calcium triggers release of packets of acetylcholine (ACh).

(5) ACh esterase (ACh E) breaks ACh into acetyl and choline, which are taken up by the nerve terminal to be reformed into ACh.Detailed discussion of these rare conditions is beyond the scope of this short review but interested readers are referred to a recent review by Engel and Ohno.Diagrammatic representation of neuromuscular transmission. (1) Action potential arriving at nerve terminal triggers opening of voltage gated calcium channels (VGCCs) and entry of calcium.In women the incidence is bimodal with one peak between the ages of 16–35 years and a second over the age of 65, while in men MG is predominantly a disease of later life.Anti-ACh R antibody positive MG is rare before puberty in white Europeans.