Myasthenia gravis (MG) is a chronic antibody-mediated autoimmune disease. The most frequent form is MG with antibodies directed against the acetylcholine receptor on the postsynaptic membrane. The first step in the treatment of autoimmune myasthenia gravis consists of symptomatic therapy. If this is insufficiently effective, the next step is to start immunosuppressive treatment with corticosteroids, usually prednisolone. A corticoid-sparing agent is often added because of the long long-term side effects of high doses of corticosteroids. The position of emerging immunomodulatory therapies targeting B-and T-cells, the complement cascade, the neonatal Fc receptor, and cytokines associated with antibody production in the treatment of MG is currently unclear. However, it is likely that symptomatic treatment will remain the cornerstone in the management of patients with MG in the foreseeable future. In this review, we provide an overview of currently available symptomatic treatments and recent advances in this field. Pyridostigmine, an acetylcholinesterase inhibitor, is the most commonly used symptomatic drug for MG. Acetylcholinesterase inhibitors prolong and enhance the effect of acetylcholine on muscarinic and nicotinic receptors. In addition, there is evidence that pyridostigmine may also have an anti-inflammatory effect. Pyridostigmine is moderately effective, but side effects are frequently reported by patients. Other therapies include amifampridine and sympathomimetics such as ephedrine, salbutamol, and terbutaline. At present, there is insufficient evidence for the use of amifampridine as monotherapy or as add-on therapy to pyridostigmine. The addition of β2-adrenergic agonists to pyridostigmine may possibly be beneficial in some patients, however, well-designed randomized trials are needed to establish their efficacy. Emerging symptomatic therapies include ClC-channel blockers, fast-skeletal muscle troponin activators, and antisense oligodeoxynucleotides. These therapies appear to be promising, with fewer side effects than pyridostigmine. However, phase III clinical trials are needed to assess their effectiveness and determine their place in symptomatic treatment of MG patients.