A 58-year-old woman from Delhi presents with progressive ptosis and diplopia for 3 weeks. She reports that symptoms worsen towards the evening and improve after rest. On examination, she has bilateral ptosis that worsens with sustained upward gaze for 30 seconds. Ocular movements are restricted. Serum anti-acetylcholine receptor (AChR) antibodies are positive. Repetitive nerve stimulation shows a decremental response. What is the primary pathophysiological mechanism underlying her clinical presentation?

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