title: Clinical Profile and Outcome of Myasthenic Crisis In Central Taiwan.
abstract: BACKGROUND
  Myasthenia gravis (MG) is an autoimmune disease caused by antibodies to acetylcholine receptors of the skeletal muscle. Myasthenic crisis (MC) is a complication observed during both early and late stage MG cases. In this study, we examined current treatments and three years outcomes in patients with MG and MC. We also investigated the impact of thymectomy and systemic lupus erythematosus (SLE) in patients with MG and MC.
  
  
  METHODS
  In this retrospective study, we reviewed the medical records of all patients admitted to one teaching hospital between January 2006 and December 2014 and identified those for whom discharge diagnosis included the International Classification of Diseases, ninth revision (ICD-9) codes corresponding to MG (358.X, all extensions and all positions).
  
  
  RESULTS
  We identified 29 patients and 49 hospitalizations. Among these patients, the cause for initial hospitalization was MG in 16 cases and MC in 13 cases. Six out of the 16 MG patients were readmitted within 3 years; with 2 of the cases due to MC. Eight of the initial 13 MC patients were readmitted within 3 years, and 6 of the cases due to MC. Among these 15 MC patients, 14 were admitted to the intensive care unit (ICU), and 8 were intubation and put on mechanical ventilators. The median ICU stay was 7 days (3-45). Both MG patients who were also diagnosed with SLE experienced MC. One patient died during the first-time hospitalization, and one patient died during re-hospitalization within 2 years.
  
  
  CONCLUSIONS
  Plasma exchange (PE) is the main treatment modality of MC, and most patients in our cohort had a good response. Infection is the most common trigger of MC and a significant cause of death. Despite significant morbidity and mortality in patients with MC, a favorable long-term outcome is possible with intensive treatment. Key Words: myathenia gravis, myasthenic crisis, systemic lupus erythematosus, outcome.
authors.affiliation: Departments of Family Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Yi-Sin
authors.initials: YS
authors.lastname: Wong
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC ; Department of, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan, ROC.
authors.forename: Cheung-Ter
authors.initials: CT
authors.lastname: Ong
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Sheng-Feng
authors.initials: SF
authors.lastname: Sung
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Chi-Shun
authors.initials: CS
authors.lastname: Wu
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Yung-Chu
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Su
authors.affiliation: Departments of Neurology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan ROC.
authors.forename: Ling-Chien
authors.initials: LC
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan; D055815:Young Adult