Case of the Month #18 - myasthenic crisis

Published 01/02/2022

What is the treatment of a myasthenic crisis?

  • Start prednisolone 100mg alternate days (corticosteroids can transiently worsen symptoms)
  • Start intravenous immunoglobulin immediately (plasma exchanged may be preferred if there are specific risk factors for IVIG). There is no definite evidence to say whether IVIG or plasma exchange works better however IVIG can generally be instituted more rapidly.
  • Consider avoiding pyridostigmine/neostigmine as these may increase secretions
  • In non-ventilated patients they will need regular monitoring, including regular swallow assessments and vital capacity measurement