In myasthenia gravis , all of the following are true except

Overall, women are affected more frequently than men, in a ratio of ~3:2. The cardinal features are weakness and fatigability of muscles. The weakness increases during repeated use (fatigue) or late in the day and may improve following rest or sleep. Unrelated infections or systemic disorders can lead to increased myasthenic weakness and may precipitate "crisis" The distribution of muscle weakness often has a characteristic pattern. The cranial muscles, paicularly the lids and extraocular muscles (EOMs), are typically involved early in the course of MG; diplopia and ptosis are common initial complaints. Facial weakness produces a "snarling" expression when the patient attempts to smile. Weakness in chewing is most noticeable after prolonged effo, as in chewing meat. Speech may have a nasal timbre caused by weakness of the palate or a dysahric "mushy" quality due to tongue weakness. Difficulty in swallowing may occur as a result of weakness of the palate, tongue, or pharynx, giving rise to nasal regurgitation or aspiration of liquids or food. Bulbar weakness is especially prominent in MuSK antibody- positive MG. In ~85% of patients, the weakness becomes generalized, affecting the limb muscles as well. Ref harrison 20th edition page 3232, 3233