Clinical experience of myasthenic crisis management in Amur region

Background. Management of the myasthenic crisis remains one of the issues in clinical neurology.

Objective. Analysis of the timeframes of the myasthenic exacerbation since the disease onset, sex distribution, age predominance, specific clinical features, precipitating factors in order to investigate the efficacy of the management algorithm of the myasthenic crisis.

Materials and methods. Medical histories of 33 female and 19 male patients with myasthenia for the period of 2000 to 2003 were analyzed.

Results. In comparison with the literature data the number of mysthenic crisis in myasthenic patients was lower and did not exceed 25 %. Sex distribution 1,2 (male): 1 (female). In 70 % worsening of myasthenia appeared in the first two years of the disease: in 6 patients (46.2 %) at the age of 22–35 y. o.; in 5 patients (38.5 %) – at the age of 36–60 y. o. All patients suffered from generalized myasthenia, in three of them ocular and bulbar muscle weakness predominated. In 46.2 % of patients with crisis, thymus abnormalities were present (thymoma / hyperplasia). The most common precipitating factors were: infection (36.9 %), stress (26.3 %), misuse of the anticholinesterase drugs (15.8 %). In 5.2 % the worsening of myasthenia followed the delivery. The crisis triggering factor was not identified in 15.8 % of cases.

Conclusion. In order to prevent the exacerbation of myasthenia, generalized forms of myasthenia with poor response to anticholinesterase drugs require special attention towards patients in their first two years of the disease, including patient’s educational program on appropriate mode of drug administration and avoiding initiating factors, as well as thymectomy.

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