Myasthenic Crisis

Abstract

Myasthenic crisis is a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. Advances in critical care have improved the mortality rate associated with myasthenic crisis. This article reviews the epidemiology of myasthenic crisis and discusses patient evaluation. Therapeutic options including mechanical ventilation and pharmacological and surgical treatments are also discussed.

Myasthenia gravıs with acute respiratory failure in the the emergency department

“…Today, in modern intensive care conditions, the death rate from MC is less than 5%. 10 This case report raises many interesting points. It highlights the importance of considering neuromuscular disorders in cases of unexplained respiratory failure in an acute setting.…”

Respiratory Care for Myasthenic Crisis

“…There is a bimodal distribution of myasthenic crisis, with an early peak prior to age 55 affecting women 4:1, whereas a later peak after age 55 affecting women and men equally (Thomas et al, 1997). The average age of admission with crisis is 59 years (Wendell et al, 2011). Pregnancy is associated with an aggravation of myasthenia gravis in approximately a third of all women and myasthenic crisis in pregnancy carries high perinatal mortality (Plauche, 1991).…”

“…A number of drugs can increase the weakness in myasthenia and should be considered as possible precipitants in this setting. This is of more concern with certain antibiotics (aminoglycosides, erythromycin and azithromycin), cardiac drugs (β-blockers, procainamide, and quinidine), and magnesium (Wendell and Levine, 2011). Although corticosteroids can be used in the treatment of MG, initial treatment with prednisone led to an exacerbation of MG in almost half of patients in 1 series (Pascuzzi et al, 1984).…”

“…Myasthenic crisis may be precipitated by a variety of factors, most often a concurrent infection (Mayer, 1997;Wendell andLevine, 2011' Thomas et al, 1997). Although patients with MG can develop any common infection that can result in decompensation, the most likely source of infection is pulmonary.…”

“…Patients should be started on a low dose of the medication that is titrated to symptomatic relief (Ahmed et al, 2005). Continuous intravenous infusion of pyridostigmine as treatment for myasthenic crisis may have efficacy similar to that of plasma exchange, but it is associated with an increased risk of life-threatening cardiac arrhythmia (Wendell and Levine, 2011). Unless contraindicated, all patients should be treated with low molecular weight heparin to prevent deep vein thrombosis and pulmonary embolism (Chaudhuri and Behan, 2009).…”