Treatment of epilepsy in patients with myasthenia gravis: Is really harder than it looks?

•We detail the management of epilepsy and MG in three different clinical settings.•We report on the first epileptic surgery in a MG patient.•The coexistence of these diseases should not represent a limiting factor for their independent management. The relationship between myasthenia gravis (MG) and epilepsy has been rarely reported. As consequence, there are no specific guidelines for the management of these conditions when they mutually occur. We reported on three patients in whom epilepsy and MG are coexisting, but in different clinical settings. Two patients were treated with antiepileptic drugs which improved their symptoms. One patient has controlled the seizures after a successful anterior temporal lobectomy with no appreciable consequences to her MG. We discuss the difficulties in the management of epilepsy in patients with MG. In addition, we report on the first epileptic surgery in a MG patient, indicating that this surgical procedure as a safe option for the treatment of intractable epilepsy in patients with MG.