A crisis occurs when a patient with myasthenia gravis cannot breathe properly. Such a crisis is rare, but when it does occur, it is an emergency situation that requires immediate medical care. With proper medical care, a crisis usually subsides in a few days or weeks.

Doctors sometimes refer to a crisis as either a "myasthenic crisis" or as a "cholinergic crisis," which is caused by an overdose of cholinesterase inhibitors. The term that is used depends on the cause of the crisis. A myasthenic crisis is caused by factors like infections or surgery that make the weakness worse. Rapid changes in the dosage of the drug prednisone can also sometimes trigger a crisis. Stopping the types of medications known as cholinesterase inhibitors can trigger a crisis in some patients, just as an overdose of these drugs can lead to a cholinergic crisis. In addition, there are certain medications that can make the symptoms of myasthenia gravis worse. Using these drugs could trigger a myasthenic crisis.

Patients having a crisis usually complain of feeling short of breath. They may also take shallow breaths and difficulty coughing. Breathing is more difficult when the patient is lying flat. Patients may also feel anxious or restless and may have a rapid heart rate.

Some patients with myasthenia gravis have weakness in the muscles that control swallowing. Dysphagia or difficulty swallowing can sometimes cause problems with breathing. These patients may experience drooling or gagging. They can cough after eating. There may be a nasal sound to their speech or their speech may be slurred. Patients may also feel anxious or restless.

The goal of treatment is to help the patient breathe. If the windpipe or trachea is closed, a tube may be placed into the trachea through the nose or mouth. In some cases, a tracheostomy may be performed. (A tracheostomy is a procedure in which a tube is placed in the trachea through a small opening made in the neck.) Some patients may need to use a respirator, a machine that breathes for them, for a short time.

How you respond during a crisis is crucial to ensuring a good outcome. It is very important that a patient remain calm. Anxiety can make symptoms worse. It is also importantfor anyone with the patient to remain calm. When others are anxious, it is much easier for the patient to become anxious.

A crisis requires immediate medical care. Patients should seek medical care as soon as they are aware of the symptoms of a crisis. It is also advisable for patients to seek help if they suspect that a crisis may be starting.

References

First published April 1, 2000
Last updated November 18, 2003
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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