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Abstracts from the Association of British Neurologists Annual Meeting 2011
171 Myasthenic crisis in the intensive care unit: a 10-year review
  1. J Spillane,
  2. C Taylor,
  3. N P Hirsch,
  4. D M Kullmann,
  5. R S Howard
  1. Institute of Neurology UCL, UK
  2. NHNN, Queen Square, London, UK


Introduction The prognosis of autoimmune myasthenia gravis (MG) has improved with a reduction in mortality from 75% to a current rate of <5%. However, approximately 20% of MG patients will experience a myasthenic crisis requiring intensive care admission during the course of their illness.

Aim To perform a 10 year audit on cases of myasthenic crisis admitted to a neurological intensive care unit.

Methods Cases of myasthenic crisis were identified from the ICU register and case notes were retrospectively reviewed

Results 38 patients were admitted in myasthenic crisis or were at risk of crisis. Five patients had multiple admissions. The average age at admission was 56.7. Twenty-five were female. Thirteen were male. Average disease duration at ICU admission was 2.6 years. Thirteen patients presented in crisis. 79% of patients were acetylcyholine receptor antibody positive. 13 % tested positive for MuSK antibodies and 7.8 % were seronegative. 31.5% of patients had a history of thymectomy. 58% of patients had a precipitating systemic infection. 50% required invasive mechanical ventilation. 80% received IVIG and 11% were treated with plasma exchange. The average duration of ICU stay was 11.5 days. There were four deaths all due to respiratory failure and sepsis.

Conclusion MG continues to be a serious disease with a considerable morbidity and mortality. Management of myasthenic crisis requires specialised neuro-intensive care facilities.

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