Fast Five Quiz: Myasthenia Gravis Emergency Management

Richard Nowak, MD, MS


July 07, 2021

Current guidelines recommend that patients aged 18-50 years with acetylcholine receptor antibody-positive generalized MG should consider thymectomy to improve clinical outcomes. The multicenter, randomized trial of thymectomy in patients with MG (MGTX Study) favored thymectomy plus prednisone in reducing hospitalizations due to MG exacerbations, as well as the use of immunotherapy.

For patients with generalized MG, immunotherapy with intravenous immunoglobulin may reduce symptoms, but it does not appear to diminish the activity of the disease.

Cooling may recover neuromuscular transmission. In patients with ptosis, placing ice over an eyelid will lead to cooling of the lid, prompting resolution of the ptosis (ice pack test). This improvement is usually short lasting.

A rapid-onset, nondepolarizing agent is the preferred paralytic agent during an exacerbation, which may delay the onset of paralysis. Compared with succinylcholine, these agents do not result in unwanted prolonged paralysis.

Learn more about the emergency management of patients with MG.


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