Universität zu Köln

Stetefeld, Henning R. and Schroeter, Michael (2018). Myasthenic Crisis. Forschritte Neurol. Psychiatr., 86 (5). S. 301 - 308. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-3522

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Abstract

Myasthenic crisis is the life threatening maximal manifestation of myasthenia gravis. Severe dysphagia and respiratory insufficiency demand admission to an intensive care unit (ICU). At variance, the timely recognition and treatment of myasthenic exacerbation may prevent a manifesting crisis. This reviews deals with red flags that pronounce exacerbation and crisis. Myasthenic crisis is an important differential diagnosis of bulbar symptoms and dysphagia. We elaborate on a structured and comprehensive approach to myasthenic crisis on the ICU. Hallmarks of therapy are symptomatic treatment with acetylcholine esterase inhibitors, plasmapheresis or immunoadsorption, polyvalent immunoglobulins, an early start of steroids and immunosuppressants, namely azathioprine, and a consequent escalation to monoclonal antibody therapy, with rituximab being the first choice. Special demands in ICU treatments are a structured weaning concept, consequent treatment of comorbidities and complications, first and foremost infections, dysphagia management, and comprehensive prevention and treatments of delirium.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stetefeld, Henning R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeter, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-187620
DOI:	10.1055/a-0599-0811
Journal or Publication Title:	Forschritte Neurol. Psychiatr.
Volume:	86
Number:	5
Page Range:	S. 301 - 308
Date:	2018
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-3522
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NONINVASIVE VENTILATION; CLINICAL-FEATURES; RESPIRATORY-FAILURE; PLASMA-EXCHANGE; CARE-UNIT; GRAVIS; MORTALITY; IMMUNOADSORPTION; COMPLICATIONS; INTUBATION Multiple languages Clinical Neurology; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18762