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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 53, Num. 2, 2005, pp. 241-241
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Neurology India, Vol. 53, No. 2, April-June, 2005, pp. 241
Letter To Editor
Management of myasthenic crisis
Kumar Sudhir, Rajshekher G., Prabhakar S.
Department of Neurological Sciences, Apollo Hospitals, Hyderabad - 500 033
Correspondence Address: Department of Neurological Sciences, Apollo
Hospitals, Hyderabad - 500 033
Date of Acceptance: 08-Apr-2005
Code Number: ni05076
Related article: ni05077
Sir,
I read with interest the recent article by Murthy et al .[1] It provides excellent data regarding the management and outcome of patients with myasthenic crisis. I would like to make certain observations.
First, Murthy et al have utilized the neostigmine test for confirmation of diagnosis. I would like to emphasize that the edrophonium (Tensilon) test is an excellent alternative for this purpose. It may even be better as the test result is obvious in 1-2 minutes, as compared to neostigmine that requires 15-30 minutes. Tensilon test has a relatively high sensitivity and specificity,[2] and the incidence of serious complications is only 0.16%.[3]
Secondly, it is important to differentiate myasthenic crisis from cholinergic crisis. The edrophonium test allows for this differentiation and this may help in optimizing the treatment.
Thirdly, Murthy et al started all their patients on steroids prior to discharge. We agree with the approach, however, caution is required as steroids may exacerbate weakness in a subgroup of patients with myasthenia. Therefore, it is advisable to keep patients hospitalized after initiating steroids till clinical improvement begins, as exacerbations after that are unusual.
Finally, Murthy et al have shown the effectiveness of low-volume plasma exchanges in myasthenic crisis, which is similar to our observations.[4] It is particularly important in the Indian scenario to minimize the cost of treatment. It is encouraging to note that plasmapheresis was shown to be superior to intravenous immunoglobulins in treating myasthenic crisis in an earlier study.[5]
REFERENCES
| 1. |
Murthy JM, Meena AK, Chowdary GV, Naryanan JT. Myasthenic crisis:
Clinical features, complications and mortality. Neurol India 2005;53:37-40. Back
to cited text no. 1 [BIOLINE] |
| 2. | Pascuzzi RM. The edrophonium test. Semin Neurol 2003;23:83-8. Back to cited text no. 2 |
| 3. | Ing EB, Ing SY, Ing T, Ramocki JA. The complication rate of edrophonium testing for suspected myasthenia gravis. Can J Ophthalmol 2000;35:141-4; discussion 145. Back to cited text no. 3 |
| 4. | Kumar S. Manual (low-volume) plasmapheresis: An effective and safe therapeutic procedure in acute neurological illnesses. Ann Indian Acad Neurol 2004;7:439-40. Back to cited text no. 4 |
| 5. | Stricker RB, Kwiatkowska BJ, Habis JA, Kiprov DD. Myasthenic crisis. Response to plasmapheresis following failure of intravenous gamma-globulin. Arch Neurol 1993;50:837-40. Back to cited text no. 5 |
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