An approach to myasthenic crisis

Abstract

Thanks to the advance of the treatment strategy, such as an introduction of early fast–acting treatment (EFT), the rate of myasthenic crisis has reduced recently. However, we still encounter this condition occasionally. The result of Japanese multicenter study shows that the overall rate of crisis is 10.2% among all myasthenia gravis (MG) patients and that thymoma–associated MG has especially high incidence. Those who received EFT revealed lower rate of crisis compared to those without EFT. There are some risk factors of myasthenic crisis. Patients showing bulbar palsy or difficulty breathing are vulnerable to crisis when the certain condition such as infection, surgery, stress or intravenous methyl prednisolone pulse therapy were added. Once patients developed crisis, intubation has to be performed promptly, and anti–cholinesterase should be discontinued. Plasma exchange is the most effective procedure to treat myasthenic crisis. Intravenous methyl prednisolone pulse therapy is also recommended.