Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 6 Issue 9

Myasthenia Gravis Crisis Treatment Modalities

Ayaz Gen1*, Saagar Pamulapati1, Jin Tao1 and Vibhav Bansal2

1Internal Medicine, MercyHealth, USA
2Interventional Neurology, Mercyhealth, USA

*Corresponding Author: Ayaz Gen, Internal Medicine, MercyHealth, USA.

Received: June 18, 2023; Published: August 21, 2023


Myasthenia Gravis is a rare disorder, with an incidence rate of approximately 20 per 100,000 people in the US. It is characterized by muscle weakness that worsens with exertion and improves with rest [1]. Often, the first presenting manifestation is involvement of extrinsic ocular muscles. Myasthenia can progress to other limb musculature as well as other bulbar muscles. The etiology of this disorder is unknown, but it is caused by circulating antibodies directed against acetylcholine receptors at the neuromuscular junction (NMJ). This disease process is highly treatable, especially with prompt recognition. A few of the main treatments involve immunoglobulins and plasma exchange. Here, we report a case of the complex nature of myasthenia crisis and the efficacy and length of appropriate treatments. A 79-year-old female with a past medical history of myasthenia gravis, presented with worsening shortness of breath that started the previous day. Chronically on pyridostigmine, she had an exacerbation of symptoms and entered into a crisis which involved extensive support such as intubation, ventilation, aggressive medical therapy, and use of intravenous immunoglobulins (IVIG) and plasma Exchange (PLEX). The patient was subsequently extubated and finished PLEX and IVIG courses. She continued to exhibit marked dysphagia, however, which required speech therapy and enteral feeding. Unfortunately, patient opted for discharge home with hospice care, as she no longer wanted to be treated despite her persistent dysphagia. This case highlights the importance of recognizing myasthenic crisis, the potency and efficacy of treatments, and associated complications.

Keywords: Myasthenia Gravis; Immunoglobulins; Plasma Exchange; Acetyl Choline Receptor; Intravenous Immunoglobulins


  1. Jayam Trouth Annapurni., et al. “Myasthenia gravis: a review”. Autoimmune Diseases2012 (2012): 874680.
  2. Beloor Suresh A and Asuncion RMD. “Myasthenia Gravis”. In: Stat Pearls. Treasure Island (FL): StatPearls Publishing (2022). 
  3. Wendell Linda C., et al. “Myasthenic crisis”. The Neurohospitalist1 (2011): 16-22.
  4. Hogan Christopher., et al. “Acute Myasthenia Crisis: A Critical Emergency Department Differential”. Cureus8 (2020): e9760.
  5. Dresser Laura., et al. “Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations”. Journal of Clinical Medicine11 (2021): 2235.
  6. Murthy Jagarlapudi MK. “Myasthenic Crisis - Comorbidities, Complications, Long-Term Outcomes: The Challenges”. Annals of Indian Academy of Neurology4 (2019): 472-473.
  7. Roper Jamie., et al. “Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department”. The Journal of Emergency Medicine6 (2017): 843-853.
  8. Wijdicks Eelco FM. “Breaking Down Myasthenic Crisis”. Neurocritical Care3 (2020): 875-879.
  9. Barth D., et al. “Comparison of IVIg and PLEX in patients with myasthenia gravis”. Neurology23 (2011): 2017-2023.
  10. Bird Shawn J., et al. “Myasthenic Crisis”. UpToDate (2021).


Citation: Ayaz Gen., et al. “Myasthenia Gravis Crisis Treatment Modalities". Acta Scientific Neurology 6.9 (2023): 24-26.


Copyright: © 2023 Ayaz Gen., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate32%
Acceptance to publication20-30 days

Indexed In

News and Events

Contact US