Myasthenic crisis: Clinical features, complications and mortality
BACKGROUND AND OBJECTIVE: Myasthenic crisis is a life-threatening complication of myasthenia gravis (MG) and when treated aggressively is associated with good outcome. MATERIALS AND METHODS: Retrospective study of case records of patients with episodes of myasthenic crisis. RESULTS: Twenty-one (22%)...
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Published in | Neurology India Vol. 53; no. 1; pp. 37 - 40; discussion 40 |
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Main Author | |
Format | Journal Article |
Language | English |
Published |
India
Medknow Publications on behalf of the Neurological Society of India
2005
Medknow Publications & Media Pvt. Ltd |
Subjects | |
Online Access | Get full text |
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Summary: | BACKGROUND AND OBJECTIVE: Myasthenic crisis is a life-threatening
complication of myasthenia gravis (MG) and when treated aggressively is
associated with good outcome. MATERIALS AND METHODS: Retrospective
study of case records of patients with episodes of myasthenic crisis.
RESULTS: Twenty-one (22%) of the 95 patients with MG (9 with thymoma),
experienced 23 episodes of myasthenic crisis, 3 (33%) in patients with
thymoma. The crisis episodes occurred within 2 years of disease onset
in 11 (52%) patients. Infection was the most common primary precipitant
of the crisis occurring in 65%. The median duration of the crisis
episode was 11 days (7-39 days), and the median neurological intensive
care unit stay was 15 days (range 9-47 days). Fifteen (65%) episodes
were treated with small volume plasma exchange (PE) and 8 (35%)
episodes received intravenous immunoglobulin (IVIg). The time taken for
disease stabilization, the median number of days for extubation, was 8
days (range 7-12) in the PE group and 10 days (range 7-39) in the IVIg
group. Disease stabilization could not be achieved in one patient in
the IVIg group. Ventilator-associated pneumonia (VAP) was the commonest
complication, seen in 30%. Two (8%) of the 23 episodes of crisis were
fatal, one resulting from VAP and septicemia, and the other due to
crisis itself. All the 19 patients who survived to discharge had
complete resolution of admission symptoms. CONCLUSIONS: In patients
with myasthenic crisis, both therapeutic options, PE and IVIg, are
equally effective in disease stabilization. To achieve good outcomes
all efforts should be directed at decreasing the duration of intubation
and also aggressively treating the associated medical complications. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0028-3886 1998-4022 |
DOI: | 10.4103/0028-3886.15050 |