Types of myasthenia gravis crisis

Written by Tang Bo
Neurology
Updated on September 13, 2024
00:00
00:00

Myasthenic crises are categorized into three types, all resulting from worsening conditions or improper treatment, leading to respiratory muscle weakness or paralysis and subsequent difficulty in breathing. The first type occurs due to various triggers or reduction in medication, or after the application of acetylcholinesterase inhibitors which temporarily alleviate the crisis, known as the cholinergic crisis. The second type is a result of excessive use of acetylcholinesterase inhibitors during a cholinergic crisis. Beyond respiratory difficulties, symptoms may also include signs of toxicity such as vomiting, abdominal pain, diarrhea, pupil constriction, excessive sweating, drooling, increased tracheal secretions, and potential muscle tremors, spasms, as well as anxiety, insomnia, confusion, seizures, and coma. The third type is the paradoxical crisis, where neither ceasing nor increasing medication doses alleviates the symptoms, typically occurring after long-term, high-dose medication use.

Other Voices

doctor image
home-news-image
Written by Zhang Hui
Neurology
56sec home-news-image

What is myasthenia gravis?

Myasthenia gravis is a group of neuromuscular junction disorders and is also an autoimmune disease of the nervous system. It primarily involves the production of certain antibodies in the body that attack the acetylcholine receptors on the postsynaptic membrane of the neuromuscular junction. This results in the inability of nerve impulses to be effectively transmitted to the muscles, causing the muscles to lose neural control, leading to weakness of the limbs. This weakness is typically more pronounced in the evening than in the morning, with symptoms being lighter upon waking and worsening in the afternoon. As the disease is caused by an autoimmune response, a major focus of treatment is to suppress this abnormal immune reaction, primarily through the administration of corticosteroids. Additionally, many patients with myasthenia gravis also exhibit thymus abnormalities, necessitating thorough CT examinations of the thymus.

doctor image
home-news-image
Written by Zhang Hui
Neurology
1min 1sec home-news-image

Myasthenia gravis should not use what medicine?

Myasthenia gravis is a neuromuscular junction disease in neurology, primarily due to some synaptic dysfunction, leading to pathological fatigue and general weakness in patients. Patients with myasthenia gravis often experience exacerbation of the disease due to fatigue or infection, and certain medications can severely affect synaptic function, worsening the condition, and are therefore not to be used. The medications to avoid mainly include the following types: The first type is aminoglycoside antibiotics, which can exacerbate the transmission at the neuromuscular junction. Second, quinolone antibiotics should also be avoided as much as possible. Third, some antiarrhythmic drugs can also decrease the excitability of the fascia and are not recommended. Additionally, some drugs like morphine, benzodiazepines, and receptor blockers should also be contraindicated or used with caution.

doctor image
home-news-image
Written by Tang Bo
Neurology
1min 10sec home-news-image

Myasthenia Gravis Clinical Manifestations

The clinical manifestations of myasthenia gravis include fluctuating weakness of specific striated muscles that is fatigue-prone. Symptoms are generally milder in the morning and worsen by night, increasing after sustained activity and alleviating after rest. Additionally, some patients may experience ocular muscle weakness, presenting with ptosis and diplopia, which could be among the earliest symptoms. Eye movement disorders may occur, preventing the eyes from looking to one side, and pupil abnormalities may be present. Facial muscle weakness can lead to cheek puffing and air leakage, inability to close the eyes, or asymmetry of the mouth, resembling a forced smile. There may also be weakness in the masticatory muscles, leading to difficulties in chewing and swallowing, potential speech impairments, and coughing when drinking water. Neck muscle weakness may manifest as difficulty in lifting the head. Muscle weakness can affect various limbs, primarily proximally, and respiratory muscle weakness can lead to breathing difficulties and dryness.

doctor image
home-news-image
Written by Zhang Hui
Neurology
44sec home-news-image

How is myasthenia gravis diagnosed?

Myasthenia gravis is essentially an immunoreactive disease in neurology, primarily caused by immune dysfunction in the body, leading to the production of autoantibodies. These antibodies attack the acetylcholine receptors on the postsynaptic membrane, resulting in corresponding clinical symptoms such as ptosis, diplopia, and general fatigue. The examination of myasthenia gravis mainly includes the following aspects: first, the completion of the Tensilon test, and if the test is positive, myasthenia gravis should be considered; second, the examination should include repetitive nerve stimulation electromyography, and if there is a significant decrement in wave amplitude, this disease should be considered; third, relevant blood tests should be conducted, mainly to check for acetylcholine receptor antibodies, as positive results for these antibodies are important in supporting this diagnosis.

doctor image
home-news-image
Written by Zhang Hui
Neurology
1min 16sec home-news-image

Is it dangerous to have a fever with myasthenia gravis?

Myasthenia gravis is a disease of the neuromuscular junction, essentially an autoimmune inflammatory response that causes generalized weakness and fatigue of the skeletal muscles, with symptoms that are less severe in the morning and worsen by the evening, and fluctuate over time. The weakness can be alleviated by rest. When patients with myasthenia gravis develop a fever, it is generally considered to be caused by an infection, perhaps a viral infection such as an upper respiratory tract infection, which can also induce fever. In such cases, the main treatment involves drinking plenty of water and consuming fresh vegetables and fruits. If necessary, some antiviral medications and antipyretics may be administered. If the fever is due to a bacterial infection, symptomatic treatment should be accompanied by the appropriate antibiotics. However, the choice of antibiotics must be made with caution. Patients with myasthenia gravis should not use aminoglycosides or fluoroquinolones, as these could exacerbate their condition. Penicillins or cephalosporins may be used instead. (Please consult a professional physician for specific medication guidance.)