Myasthenia Gravis

Author: Ammar M Salem / Editor: Yasmin Sultan / Reviewer: Kaja Rasheed, Kathryn Blackmore / Code: A5 / Published: 06/09/2021

Description:

Myasthenia gravis does not present often to the Emergency Department. However, it can manifest as respiratory failure. The emergency physician should have a high index of suspicion for neuromuscular causes of respiratory failure, and the diagnosis needs to be considered in any case of unexplained respiratory failure.

By the end of this session you will be able to:

  • Describe the key pathophysiological changes in myasthenia gravis
  • Recognise different clinical presentations of myasthenia gravis
  • Explain a rational system for investigations in a patient with suspected myasthenia gravis
  • Identify the important therapeutic modalities involved in the treatment of myasthenic crisis
  • List conditions that may mimic myasthenia gravis

References:

  1. Sathsivam S. Steroids and immunosuppressant drugs in myasthnia gravis. June 2008 vol 4 No 6. DOI: 10.1038/ncpneuro0810.
  2. Thanvi BR, Lo TC. Update on myasthenia gravis. Postgrad Med J. 2004 Dec;80(950):690-700.
  3. Vincent A, Clover L, Buckley, et al. Evidence of underdiagnosis of myasthenia gravis in older people. Journal of Neurology, Neurosurgery & Psychiatry. 2003;74:1105-1108.
  4. Murthy JMK. Thymectomy in myasthenia gravis. Neuorology India Jul-Aug 2009 Vol 57 Issue 4.
  5. Calhoun RF, Ritter JH, Guthrie TJ et al. Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 1999;230:555-61.
  6. Urschel JD, Grewal RP. Thymectomy for myasthenia gravis. Postgraduate Medical Journal. 1998;74:139-144.
  7. Alshekhlee A, Miles JD, Katirji B et al. Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals. Neurology 2009;72:1548-1554.
  8. Juel VC. Myasthenia gravis: management of myasthenic crisis and perioperative care. Seminars in neuorology, Volume 24, Number 1, 2004.
  9. Bedlack RS, Sanders DB. How to handle myasthenic crisis. Essential steps in patient care. Postgraduate medicine, Volume 107, Number 4, April 2000.
  10. Bershad EM, Feen ES, Suarez JI. Myasthenia gravis crisis. Southern medical journal, Vol 101, No 1, January 2008; 0038-4348/0-2000/10100-0063.
  11. Gold R, Schneider-Gold C. Current and future standards in treatment of myasthenia gravis. Neurotherapeutics, vol 5, 535-541, October 2008.
  12. Hetherington KA, Losek JD. Myasthenia gravis. Myasthenia vs. cholinergic crisis. Pediatric emergency care, Vol 21, No 8, August 2005; 0749-5161/05/2108-0546.
  13. Lacomis D. Myasthenic crisis. Neurocritical care, Vol 3, 2005;03:189-194.
  14. Armstrong SM, Schumann L. Myasthenia gravis: diagnosis and treatment. Clinical practice, Vol 15, Issue 2, February 2003.
  15. Diaz-Manera J, Rojas-Garcia R, Illa I. Treatment strategies for myasthenia gravis. Expert opinion.Pharmacother. 2009;10(8):1329-1342.
  16. Hart IK, Sharshar T, Sathasivam S. Immunosuppressant grugs for myasthenia gravis. Journal of Neurology, Neurosurgery & Psychiatry 2009 80:5-6; 10.1136/jnnp.2008.144980
  17. Gajdos P, Chevret S, Toyka KV. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database of systemic Reviews 2008. Issue 1. Art. No.: CD002277. DOI: 10.1002/14651858.CD002277.pub3.
  18. Smulowitz PB, Zeller J, Sanchez LD, et al. Myasthenia gravis: lessons for the emergency physicians. European journal of emergency medicine. 2005, Vol 12 No 6;12:324-326.
  19. Rabinstein A, Wijdicks EFM. BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation. Neurology 2002;59:1647-1649.
  20. Benatar M, Kaminski H. Meidcal and surgical treatment for ocular myasthenia. Cochrane Database of Systemic Reviews 2006, Issue 2. Art. No.: CD005081. DOI: 10.1002/14651858.CD005081.pub2.
  21. Gajdos P, Chevret S, Toyka K. Plasma exchange for myasthenia gravis.Cochrane Database of Systemic Reviews 2002, Issue 4. Art. No.: CD002275. DOI: 10.1002/14651858.CD002275.
  22. Seneviratne J, Mandrekar J, Wijdicks EF et al. Noninvasive ventilation in myasthenia gravis. Arch Neural 2008;65(1):54-58.
  23. Carr AS, Cardwell CR, McCarron P; et al. A systematic review of population based epidemiological studies in Myasthenia Gravis. BMC Neurol. 2010;10:46. Epub 2010 Jun 18.

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