Myasthenic Crisis: Therapy and Prognosis

Abstract

The clinical characteristics and management of patients with myasthenic crisis admitted to a Neurological intensive Care Unit over the last years period were retrospectively reviewed. Twentynine patients were admitted in myasthenic crisis, five of whom had multiple admissions. The frequency of crisis among our myasthenic patients was 23.4%. Median age at onset of crisis was 36 (range, 11 to 72), the ratio of women to men was 3:1, and the median interval from onset of mysthenic symptoms to first crisis was 15 months. Eleven patients (30%) admitted in crisis required intubation and mechanical ventilation, lasting 1 to 8 days (median 3 days). In 26 episodes, after intubation and meticulous airway cleaning with aspiration of secretions, patients were able to compansate respiratoy and oropharyngeal weakness without ventilatory support. Infection was the most common precipitating factor (54%), followed by no obvious cause (27%). Most of the patients received combined immunotherapy; patients were treated with corticosteroids or IVIG in 34 and 17 crisis, respectively. The proportion of complications was 32%, one patient died of acute myocardial infaction. Ninetysix % of patients who survived showed functionally good improvement.