Diagnosis of MG

How can early MG be reliably diagnosed?  I have intermittent ocular symptoms, with my eyelid occasionally closing and will not open until I physically open it.  Then it is completely normal.  The problem is, neither I nor my neurologist can induce this, by any of the usual methods (upward gaze, downwards gaze, keeping the eyes closed, etc).  He feels an emg will be of little use, the antibody test was neg, and a head MRI was normal.  I have a chest CT and an NCV pending, but if all those things are normal, what then?  The neurologist feels we will just have to wait and see, and that is ok by me as the symptoms come and go and don't seem to bother me much.  It is only my eyelid at this point, and it only happens at night and only occasionally.  Any suggestions as to furthur testing, or just wait and see if symptomatology progresses?
Thank you very much.

[CCF-Neuro-M.D.-RPS]

Dear nurse12hr:

I am sorry that your having eye ptosis.  What happens when you stress the eyelid , such as blinking fast for 50 blinks-do you get ptosis?  One of the clinical signs of MG is that with muscle use the muscle fatigues due to decreased acetylcholine receptor function.  Will the acetylcholonesterase inhibitor reverse the ptosis when it is present?  Which antibody did you send for-I hope both the blocking and binding types.  Single fiber EMG should be able to help out in this situation.  Have they ruled out other myopathies or neural junction disorders?  Metabolic disorders can also give a picture of ptosis.

Sincerely,

CCF Neuro MD