CC BY-NC-ND 4.0 · Neurology International Open 2018; 02(01): E10-E15
DOI: 10.1055/s-0043-118441
Review
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Myasthenia Gravis – Exacerbation and Crisis

Michael Schroeter
Department of Neurology, University Hospital, University of Cologne, Cologne, Germany
,
Günther Thayssen
Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Julia Kaiser
Department of Neurology, LVR Clinic Bonn, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2018 (online)

Abstract

Myasthenic exacerbation and crisis are most critical incidences in myasthenia gravis. Even nowadays myasthenic crisis is a life-threatening condition, with a lethality of 2–3%. We review means of avoiding myasthenic exacerbation and crisis, elaborate on red flags and how to establish highly-active therapy in a timely manner. This includes the reasonable use of cholinesterase inhibitors, immunoadsorption or plasma exchange, as well as immunoglobulins and steroids. Immunosuppressive agents and monoclonal antibody therapy add to the therapeutic options.

Intensive care of myasthenic patients includes the management of dysphagia and delirium. Importantly, the perioperative management of patients undergoing thymectomy and weaning are specific challenges in the treatment of myasthenic patients in the ICU.

Establishing timely consequent immunosuppression and treatment of myasthenic patients in specialized outpatient centres help to avoid repetitive exacerbations and crises.