Abstract: As of 1986 a laboratory for the diagnosis of Malignant Hyperthermia (MH) was established at the University of Antwerp which since then served as the national reference laboratory for this rare anesthetic complication. Our unit is an accredited lab within the network of the European Malignant Hyperthermia Group and thus has had the chance to attain a solid practical expertise in this disorder, as well as to collaborate in several multicentre studies on MH.The present review summarizes what collaborative international research has taught us about MH over the last 3,5 decades, and covers evolving insights in such topics as pathophysiology, clinical presentation, treatment, anesthesia for patients with an increased risk of developing MH, molecular genetics, diagnostic work-up and relationship to other myopathies.