Abstract Details

Title Clinicodemographic Characteristics and Outcomes of Patients with Myasthenic Crisis and Impending Myasthenic Crisis: An Ambispective Study from a Tertiary Care Centre in India

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-021

Objective To determine the clinicodemographic characteristics of patients with myasthenic crisis or impending myasthenic crisis and their outcomes at 3 months.

Background Myasthenia Gravis (MG) is an autoimmune disorder affecting neuromuscular transmission, with 15-20% of patients experiencing a myasthenic crisis during their lifetime. This study aims to explore the clinical characteristics and outcomes of patients presenting with myasthenic crisis or impending crisis and to assess their outcomes after 3 months.

Design/Methods This Ambispective observational study included MG patients in crisis or impending crisis, and a comparison group of generalized MG patients without crisis. The prospective arm included 44 patients with 52 episodes, and the retrospective arm reviewed 46 patients with 47 episodes since January 2016. Clinical profiles were collected, and MG status was assessed using the MGFA staging. Outcomes were evaluated at discharge and 3 months post-discharge using the MG-ADL score.

Results The mean age of the 90 patients was 42.98 ± 15.13 years, with 60% male. Generalized MG was the initial presentation in 68.89%, with ocular (16.7%) and bulbar (6.7%) forms being less common. AchR antibodies were positive in 80% of patients, and thymic abnormalities were present in 47.78%, with thymectomy performed in 79.07% of these cases. Patients with thymic abnormalities were more likely to experience three or more crises (33.3% vs. 8.6%, p=0.014). Infection significantly increased the risk of progression from impending to full crisis [OR: 5.368 (1.24, 23.19), p=0.024]. The 3-month mortality rate was 7.78%, primarily due to infection. MuSK antibody positivity was more frequent in crisis patients than in those without a crisis (8.9% vs. 0%, p=0.014).

Conclusions Thymic abnormalities increased the risk of recurrent myasthenic crises, while infections played a key role in progressing from impending to full crisis and were the leading cause of mortality. Anti-MuSK antibodies were an independent risk factor for myasthenic crisis in generalized MG patients.

Authors/Disclosures
Shiny Joy, MD, MBBS PRESENTER	Dr. Joy has nothing to disclose.
Rajesh Kumar Singh	Rajesh Kumar Singh has nothing to disclose.
Manjari Tripathi, MD (ALL INDIA INSTITUTE OF MEDICAL SCIENCES)	Dr. Tripathi has nothing to disclose.
Rohit Bhatia, MD, MBBS, DM	Dr. Bhatia has nothing to disclose.
Achal K. Srivastava, MD, FAAN (AIIMS)	Dr. Srivastava has nothing to disclose.
Deepti Vibha, MD (All India Institute of Medical Sciences)	Dr. Vibha has nothing to disclose.
Arunmozhimaran Elavarasi, MD (All India Institute of Medical Sciences)	Dr. Elavarasi has stock in Pfizer. Dr. Elavarasi has stock in PGHL. The institution of Dr. Elavarasi has received research support from All India Institute of Medical Sciences, New Delhi. The institution of Dr. Elavarasi has received research support from Indian Council for Medical Research.
Animesh Das, MD (All india institute of medical science)	Dr. Das has nothing to disclose.
Awadh Kishor Pandit, MD, MBBS, DM	Dr. Pandit has nothing to disclose.
Anu Gupta	The institution of Dr. Gupta has received research support from ICMR.
Ayush Agarwal, DM (All India Institute of Medical Sciences, New Delhi)	Dr. Agarwal has nothing to disclose.

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