Myasthenia Gravis Crisis

Abstract

• Crisis in myasthenia gravis is defined as rapidly progressively respiratory and bulbar muscle weakness.

• In crisis, do not spend too much time differentiating whether the patient is in myasthenic or cholinergic crisis. This differentiation not only is unnecessary, but also is often difficult. Your main goal is to keep the patient alive.

• It is important to recognize and treat impending crisis; impending crisis is suspected when the patient presents with sleeping difficulties, tachycardia, dyspnea, and dysphagia.

• The goal of therapy is to strengthen respiratory and bulbar muscles; less important are limb and eye muscles.

• Try to identify underlying causes for crisis: infection, electrolyte abnormalities, stress, excessive use of cholinesterase inhibitors, postoperative status. Some causes of crisis remain unknown.

• Remember: In crisis, treat the infection aggressively with the best available antibiotic. Do not be concerned that the antibiotic may affect neuromuscular transmission adversely.

• In crisis, it is best and most practical to stop all cholinesterase inhibitors (e.g., pyridostigmine [Mestinon]), because the patients at this point are in the intensive care unit and are resting, and second, these drugs causes excessive tracheal secretion and may cause cholinergic crisis.