Abstract Details

Myasthenic crisis represents a severe worsening of myasthenia gravis resulting in airway compromise requiring ventilatory support. Data regarding factors involved in readmission are limited. 

Evaluate patient characteristics, treatments, outcomes, and readmission data of patients admitted for impending or manifest myasthenic crisis.

We performed a retrospective review of patients admitted with impending or manifest myasthenic crisis to the University of California, Irvine Medical Center between July 2010 and July 2020. Patients were included if they required non-invasive or invasive ventilatory support, or if admitted with concern for progression to respiratory failure. Repeat crisis was determined as a subsequent worsening after clear recovery from the prior crisis event.

58 admissions for myasthenic crisis were identified among 35 patients, allowing for multiple admissions provided they were distinct crisis events. Eight patients (23%) had more than one admission for myasthenic crisis, with a median of 81 days (13 to 2,037) between hospitalizations. Myasthenic crisis hospitalizations occurred an average of 3.8 years following the diagnosis of myasthenia gravis. 29 of 58 admissions occurred three or more years following diagnosis. Median length of hospital stay was 10 days. Patients were treated with plasma exchange (PLEX) in 32 of 58 admissions, intravenous immunoglobulin (IVIg) treatment in 28 of 58 admissions, and two patients were treated with both treatments during the same admission. Two admissions for myasthenic crisis resulted in death, both associated with significant co-morbid conditions.

Repeat hospitalization for myasthenic crisis most often occurred within the first three months following a prior crisis event. Half of all admissions for myasthenic crisis occurred three or more years following the diagnosis of myasthenia gravis. Length of hospitalization for clearly defined myasthenic crisis may be longer than what has been reported by some prior studies. Nearly a quarter of our patients had multiple distinct crises occurring within short intervals.