High-dose Steroids Versus Standard Treatment for Myasthenic Crisis

Abstract

Background: Previous literature revealed the possible benefit of high-dose steroids in myasthenic crises. Steroids are more economical than standard therapy, especially in resource-poor settings. More data are therefore needed about the utility of steroids for the myasthenic crisis. Objective: The outcomes were compared between standard therapy (intravenous immunoglobulin [IVIg] or plasmapheresis [PLEX]) and high-dose steroid (intravenous methylprednisolone) for the myasthenic crisis. The primary outcome was the length of hospital stay. The secondary outcomes were the length of intubation, intensive care unit stay, readmission rate due to crisis, posttreatment muscle score, and mortality. Methodology: This study was a single-center, longitudinal, 12-year retrospective study. Sixty-five patients were analyzed. A comparison of means was made between the outcomes of the two groups. Regression analysis was done for hospital stay and intubation outcomes. Side effects of treatment were determined. Results: Shorter hospital stay (P = 0.001), shorter intubation length (P = 0.000), and shorter intensive care (P = 0.000) were observed in the steroid group. Mortality (P = 0.187) and muscle score (P = 0.281) were comparable between the two groups. There was a trend toward lesser readmission (P = 0.097) and longer time to readmission (P = 0.069) in the standard therapy group. The IVIg group had arrhythmias, hypotension, headache, renal impairment, and hypomagnesemia. The PLEX group had hypotension and lower limb pain. The steroid group had hyperglycemia, insomnia, infection, stomach upset, facial flushing, myopathy, and sudden death. No acute worsening of the myasthenia crisis was seen in all patients in the steroid arm. Conclusion: Data on hospital stay, intensive care days, and intubation length were better with high-dose steroids. Mortality and motor outcomes were comparable between the two groups. Readmission rates due to crisis were lower in the standard therapy group.