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Neurology India, Vol. 53, No. 1, January-March, 2005, pp. 40 Invited Comments Invited Comments Varelas PanayiotisN Department of Neurology, Director NICU Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202-2689 Related article: Myasthenic crisis: Clinical features, complications and mortality Code Number: ni05008 One of the two major neuromuscular diseases that neuro-intensivists admit to an intensive care unit (ICU) is myasthenia gravis (MG, the other, Guillain-Barre syndrome). Because MG patients develop crisis leading to intubation and mechanical ventilation infrequently, not much is known about it. Even less is known about myasthenic crisis in developing countries. The reason is the rarity of the disease per se. Modern studies from Columbia-Presbyterian and Johns Hopkins Hospitals have been published in the Western literature, but even these report few tens of cases. From these and other studies it became evident that in recent times the prognosis of myasthenic crisis has improved significantly. This is mainly due to novel treatments (such as plasmapheresis and IVIG), but, probably to a greater degree, due to early recognition and aggressive treatment of respiratory or infectious complications (such as atelectasis and aspiration pneumonia) in the ICU. For example, a more aggressive respiratory management protocol at Hopkins halved the prevalence of atelectasis and pneumonia compared to the Columbia series. Thus, any study reporting the management or outcomes of this rare situation is welcomed. Copyright 2005 - Neurology India |
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