DISEASE & TREATMENT

Crisis 411: What You Need to Know About Myasthenic Crisis

JUNE 2020 | 5 MIN READ

This article is coauthored by Ratna Sanka, MD, neurologist, University of Texas Health, San Antonio, and Phil Cogan, MA, MGFA Board of Directors and Crisis Management Expert.

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 MG makes this lesson even more important. A myasthenic crisis needs to be handled properly and quickly.1-3 There are many reasons that you may delay creating an MG crisis plan. But wouldn’t you rather prepare for a crisis that never comes than deal with one without the right information? Here’s what you need to know.

What Is an MG Crisis?

A myasthenic crisis happens when worsening myasthenic weakness requires intubation or noninvasive ventilation to avoid intubation.1 In other words, you can’t breathe without a ventilator and need immediate medical help.1,3

Red Alert: Signs You’re in Crisis

There are many reasons for shortness of breath that have nothing to do with MG but may be equally troubling, including lung disease, heart problems, anxiety and more.4 However, any one of the following could signal you’re in MG crisis:

  • In general, it feels harder to breathe.4
  • You can’t complete sentences or count to 20 without getting out of breath.3,4
  • The muscles between your ribs and above the collarbone cave in when you breathe.3
  • Your cough can’t clear saliva or phlegm.3

If you are struggling to breathe, it is very important to call 911 immediately.

What Is an Impending MG Crisis?

Before a full-blown crisis, you may experience an impending crisis. This is a flare or exacerbation that could lead to a crisis in days or weeks. The signs vary by case. Take any of them as an early warning—you’ll need closer monitoring at a hospital with aggressive treatment to prevent a full crisis.

Red Flags: Trouble with Chewing, Swallowing or Coughing

You might have a weak cough that is unable to clear your throat. You may cough frequently while eating and drinking. You could have trouble swallowing and need softer foods. Or you might get the sensation of liquids coming through your nose while swallowing.2

Other red flags are a drooping head, speech that's nasal or low volume, or needing to take a breath after every few words.3

If you experience any of these symptoms, you should go to a hospital immediately.

Yellow Flags: The Signs to Watch2,5

Although breathing, chewing, swallowing and coughing are the most troublesome signs of an impending crisis, there are many others that might be easier to miss, at least at first. These include any worsening of your MG symptoms, from double vision, eye drooping, slurred speech and arm weakness, to falling and trouble walking.

Regular appointments with your doctor and symptom tracking may help you notice these signs early.

Know the Triggers

To manage the risk of MG crisis, you need to know what can cause one. The list of known MG crisis triggers includes:3

  • Medications, such as high doses of steroids
  • Certain antibiotics
  • Some heart and blood pressure medications
  • Agents used for anesthesia
  • Magnesium
  • Illness causing fever, pneumonia or other lung infections
  • Stress from trauma or surgery

When to Call Your Neurologist. When to Dial 911.

What to do in a myasthenic crisis can get complicated. Be sure to talk with your neurologist regularly about your symptoms to help them know when things are getting out of hand.

Call Your Neurologist When You Experience:2

  • Worsening of any MG symptoms

Go to the Hospital When You Experience:2

  • Weak cough that is unable to clear your throat
  • Coughing frequently while eating and drinking
  • Trouble swallowing
  • Sensation of liquids coming through your nose while swallowing
  • Drooping head
  • Speech that's nasal or low volume
  • Needing to take a breath after every few words

Call 911 When You Experience:

  • Difficulty breathing at rest4
  • Inability to count to 20 in a single breath3,4
  • The muscles between your ribs and above the collarbone caving in when you breathe3
  • Feeling like you are drowning in your own saliva or phlegm3

Prep Others to Be Prepared

It’s important to 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. You should also teach family, friends, caregivers and coworkers about MG and the steps they may need to take if a crisis happens. Even if that day never comes, it feels good to know you have a plan in place to get through an MG crisis safely.

A complete guide to creating an MG crisis action plan is coming soon to MG United. In the meantime, please print the MGFA’s MG Wallet Card, fill it out, and carry with you at all times.

References

  1. Sanders DB, et al. Neurology. 2016;87(4):419-425.
  2. Stetefeld H, et al. Neurol Res Pract. 2019;1(19):1-6.
  3. Wendell LC, et al. Neurohospitalist. 2011;1(1):16-22.
  4. Wahls SA. Am Fam Physician. 2012:86(2):173-180.
  5. Gilhus NE, et al. Lancet Neurol. 2015;14(10):1023-1036.

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