MYASTHENIC CRISIS- ANALYSIS OF PREDISPOSING FACTORS, CLINICAL FEATURES, COMPLICATIONS AND TREATMENT OUTCOME
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 22
Abstract
BACKGROUND Myasthenia gravis is a neuromuscular junction disorder characterised by skeletal muscle weakness and fatigability. If the respiratory muscles and/ or bulbar muscles become weak, it requires respiratory assistance and the patient is said to be in myasthenic crisis. MATERIALS AND METHODS In this descriptive study, patients admitted between 01.10.2012 and 01.12.2013 in Rajiv Gandhi Government General Hospital, Madras Medical College with symptoms and signs of myasthenia crisis, fulfilling the inclusion and exclusion criteria were enrolled with informed consent. RESULTS Breathing difficulty was the predominant symptom in all the patients (96%) followed by speech (88%) and chewing (84%). Our patients had a minimum disease duration of 7 days and maximum of 1460 days and a mean of 627.16 days. 6 patients had thymoma. The most common predisposing factor was respiratory infection (28%). The duration of IMCU stay also ranged from 3 days to 40 days with a mean of 13.32 days. Three patients developed ventilator-associated pneumonia (12%). One patient developed respiratory failure, autonomic dysfunction and shock within 5 days of crisis. CONCLUSION The better survival rate in ventilated patients outweighs the preventable ventilator related complications. Standardised myasthenia crisis treatment protocol and advanced neurointensive care setup minimises the negative impact of the co-morbid conditions on myasthenic crisis. Therapeutic regimens should be tailored to the patient’s age, severity of crisis, circulatory status and comorbid conditions. Fixed standardised and combined treatment regimen is not suitable for each and every patient.
Authors and Affiliations
Jayakumar Madavan, Thamilpavai Natarajan, Lakshmi Narasimhan Ranganathan, Bhanu Kesavamoorthy
Keywords
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- EP ID EP431921
- DOI 10.14260/jemds/2018/604
- Views 62
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