Critical Care of Myasthenia Gravis in a Resource Poor Setting

Abstract

Myasthenia gravis presenting as a neurologic emergency warrants management in a critical care unit. In resource poor settings which typify much of Africa, this can be very challenging even in tertiary centers with consequently unfavorable outcomes. This study evaluated the outcomes of intensive care management of patients with myasthenia gravis in a regional teaching hospital in South East Nigeria. A retrospective study was undertaken of patients admitted into the intensive care unit of the University of Nigeria Teaching Hospital Enugu, South East Nigeria, with myasthenia gravis as a neurologic emergency. This study covered a 13-year period from 1992 to 2004. From the case records demographic data, clinical features and details of clinical management, complications, and outcomes were determined and subjected to analysis. The median age at presentation was 29 years (range, 20 to 42 y) with male:female ratio of 1:2.7. The median duration of illness before presentation to the intensive care unit was 7 months (range, 1 wk to 3 y). The median duration of stay in the unit was 15 days (range, 1 to 36 d). Two cases of septicemia and acute renal failure were recorded. The overall mortality rate was 27.3%. Sepsis is a major factor contributing to poor outcomes among patients with myasthenia gravis managed in critical care units in Nigeria. Vigorous and concerted efforts should be made to make intensive care units more effective in Africa.