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Myasthenia Gravis in the ICU

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Textbook of Neuroanesthesia and Neurocritical Care

Abstract

Autoimmune myasthenia gravis is the most prominent disorder of the neuromuscular junction encountered in the emergency department and in the intensive care unit and is caused by antibodies against nicotinic acetylcholine receptors. Its distinctive feature is muscle fatigability, leading to variable and fluctuating weakness that makes the clinical assessment difficult, and may mislead the inexperienced examiner. Treatment is both symptomatic, by supporting neuromuscular transmission with anticholinesterase drugs, as well as aimed at the underlying immune process, through immunomodulation, immunosuppression and thymectomy. However, risks are frequently underestimated, if fatiguing is not adequately appreciated, and this may lead to unnecessary mortality. This chapter aims to provide a summary of the basic pathophysiology of myasthenia in its relevance for diagnosis and treatment, as well as an overview of clinical assessment and diagnostics, identifying risks and complications. Treatment options and their indications are discussed in detail.

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Acknowledgments

Dr. Lokesh Wijesekera, Ipswich and Cambridge University Hospitals, provided electrophysiological images (Figs. 3.1 and 3.2).

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Correspondence to Maxwell S. Damian .

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Damian, M.S. (2019). Myasthenia Gravis in the ICU. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_3

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  • DOI: https://doi.org/10.1007/978-981-13-3390-3_3

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  • Publisher Name: Springer, Singapore

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