Myasthenia gravis has changed from being a frequently fatal condition with a reputation little better than motor neuron disease to a generally treatable condition over the previous century. However, the chronic, largely immunosuppressive treatment comes with the major problems of very slow response and of treatment-induced morbidity and mortality. Myasthenia gravis is a model autoimmune disease of a model physiologic structure, so is well placed for trials of novel treatments with ramifications for autoimmunity generally. There are also good animal models, so specific approaches to reinduction of tolerance can be tested. Hope of future revolutions in treatment should not hinder efforts to better understand currently available therapies and a concerted approach to ameliorate the side effects of treatment.