DISEASE & TREATMENT

Crisis 411: What You Need to Know About Myasthenic Crisis

MAY 2022 | 5 MIN READ

Do you know the signs of an MG crisis? You should.

Life eventually teaches us the importance of preparing for emergencies before they happen. But life with myasthenia gravis (MG) may make this lesson even more important, considering 15% to 20% of people living with MG experience at least one crisis in their lives.1 According to the Myasthenia Gravis Foundation of America (MGFA), a myasthenic crisis is a complication of MG characterized by worsening of muscle weakness often resulting in respiratory failure. More information on myasthenic crises is outlined below, based primarily on research conducted by Henning Stetefeld, MD, and Linda C. Wendell, MD.

A myasthenic crisis needs to be handled properly and quickly.1-3 Check out the downloadable MG Crisis Kit Checklist and MG Crisis Card designed to assist with creating a kit to help you be prepared with input from Stephanie,* a person who lives with MG. Here are some things you should know about crises.

Put your health first. Having a myasthenic crisis kit ready to go is integral to taking care of yourself.

Stephanie
Living with MG
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The signs of an MG crisis may vary from person to person, so always talk to your doctor when creating your crisis plan so you and your supporters can be aware of what to monitor.

Know the Potential Signs and Triggers to Watch1,4

Myasthenic crisis results from weakness of upper airway muscles that can lead to choking, weakness of respiratory muscles that can lead to reduced air coming in and out of the lungs, or weakness of both muscle groups.

Regular appointments and discussions with your doctor may help you learn about early signs of a crisis. Your doctor may recommend that you track symptoms regularly or use some other method to look for changes in your symptoms.

It’s important to note that there are cases where crisis symptoms are brought on more quickly, possibly due to a physical or environmental trigger. Weakness may develop within minutes to days, and it may feel difficult to breathe.1

To manage the risk of an MG crisis, it may be helpful to know what can cause one. Common MG crisis triggers include3,5:

  • Physical and environmental stressors
  • Infection
  • Surgical intervention (thymectomy)
  • Pregnancy
  • Childbirth
  • Emotional stress
  • Change in medications

If you’re introducing new medications or have a change in medications, discuss with your healthcare provider what you should be aware of and monitor. A list of cautionary drugs has been provided by the MGFA for consideration.

When to Call Your Neurologist

Knowing what to do in a myasthenic crisis may be complicated. Be sure to talk with your neurologist regularly about your symptoms so you can discuss the potential severity of your symptoms and what may be an emergency.

Potential Signs of a Crisis

Common symptoms of a potential MG crisis can include1:

  • A cough that can’t clear saliva or phlegm
  • Coughing frequently while eating and drinking
  • Sensation of liquids coming through your nose while swallowing
  • Drooping head
  • Speech that’s nasal or low volume
  • Difficulty breathing while laying down
  • Inability to count to 20 in a single breath3
  • The muscles between your ribs and above the collarbone caving in when you breathe3
  • Feeling like you are drowning in your own saliva or phlegm

Help Others Be Prepared

Print, fill out and carry an MG Crisis Card with you at all times. The card lists important information for emergency medical services to know about if an MG crisis should occur, such as emergency contact information, medicines you’re currently taking, the signs of an MG crisis and more.

Taking time to think about and prepare a kit of items for a myasthenic crisis may help provide you and your loved ones with some steps for an action plan.

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Print and fill out this MG Crisis Kit Checklist and MG Crisis Card.

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You may want to share the checklist with your family, supporters and coworkers so that they’re familiar with items in your kit, such as your current medications, including any MG treatment. Hopefully the day never comes, but it will feel good to know you have a plan in place. Be sure you’re reviewing your checklist and card regularly to confirm personal information is always accurate and up to date.

It’s important to help prepare for a myasthenic crisis ahead of time. Be sure to discuss everything in detail with your neurologist, as every case of MG is different.

References

  1. Stetefeld H, et al. Neurol Res Pract. 2019;1(19):1-6.
  2. Sanders DB, et al. Neurology. 2016;87(4):419-425.
  3. Wendell LC, et al. Neurohospitalist. 2011;1(1):16-22.
  4. Gilhus NE, et al. Lancet Neurol. 2015;14(10):1023-1036.
  5. Management of myasthenia crisis in the ED. NUEM Blog. Updated November 5, 2018. Accessed March 1, 2022. https://www.nuemblog.com/blog/myasthenia

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