Effectiveness of rehabilitation for swallowing difficulty on the patients with myasthenia crisis

Abstract

We report the effectiveness of dysphagia rehabilitation to patients who have prolonged swallowing difficulty after myasthenia gravis crisis. Three patients with late onset myasthenia gravis developed crisis triggered by respiratory infection. They were treated with a combination of plasmapheresis, tacrolimus and intravenous gamma globulin therapy. However they needed to receive mechanical ventilator management for a long time, so they underwent tracheostomy. Even after tapering from the mechanical ventilator, they were suffered from dysphagia caused by myasthenia symptom and indwelling tracheal catheter. The dysphagia rehabilitation for swallowing difficulty and appropriate food form selection according to their swallowing function made them possible to oral intake again without development of aspiration pneumonia. Monotherapy with tacrolimus was effective to improve myasthenia symptoms after crisis.