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    Subjects/Physiology/Synaptic Transmission
    Synaptic Transmission
    medium
    heart-pulse Physiology

    A 58-year-old man from Mumbai presents to the neurology clinic with progressive weakness of the ocular muscles over 3 weeks. He reports diplopia and ptosis that worsens towards the evening. On examination, he has bilateral ptosis, ophthalmoplegia, and weakness of facial muscles. Repetitive nerve stimulation shows a decremental response. Serum antibodies against nicotinic acetylcholine receptors (AChR) are positive. Which of the following best explains the pathophysiology of his neuromuscular transmission defect?

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