Therapy of myasthenic crisis.
OBJECTIVE
To investigate the frequency, causes, and characteristic features of the course of isolated myasthenic crisis (defined as acute respiratory failure with the need for mechanical ventilation). To compare the effectiveness of three different therapeutic regimens (i.e., continuous intravenous infusion of pyridostigmine, pyridostigmine plus prednisolone, and plasma exchange) in terms of duration of ventilation and outcome of patients with myasthenic crisis.


METHODS
Population-based retrospective study covering the period 1970 to 1995.


METHODS
University hospital, center for myasthenia gravis in Saxony, Germany.


METHODS
Of 235 patients with myasthenia gravis treated at our institution, 44 patients developed a total of 63 myasthenic crises (average annual incidence 2.5%).


METHODS
Myasthenic crises were treated with pyridostigmine (n = 24), pyridostigmine plus prednisolone (n = 18), and plasma exchange (n = 21).


RESULTS
There were no significant differences between the three treatment groups with respect to clinical characteristics, duration of mechanical ventilation, complications, and outcome on release from intensive care and after 3 months. Eleven (17%) patients had severe cardiac arrhythmia, which ended fatally for six patients.


CONCLUSIONS
None of the therapeutic regimens applied demonstrated any advantage over the others. All three regimens used were found to be effective and should be applied depending on the circumstances prevailing. Patients with myasthenic crisis must undergo careful cardiac monitoring, and temporary pace-making should be provided where clinically indicated.
Berrouschot
J
J
Department of Neurology, University of Leipzig, Germany.
Baumann
I
I
Kalischewski
P
P
Sterker
M
M
Schneider
D
D
D006801:Humans; D009157:Myasthenia Gravis / Q000503:physiopathology / Q000628:therapy*; D010951:Plasma Exchange; D011239:Prednisolone / Q000627:therapeutic use; D011729:Pyridostigmine Bromide / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies
D011239:Prednisolone; D011729:Pyridostigmine Bromide