Case Report: Early rehabilitation initiated in the intensive care unit for myasthenic crisis.
Akiyuki Okamoto, Yusuke Sasaki, Yuto Mizutani and 4 others
A woman with myasthenic crisis went from intubated to walking 70 m by day 23 and was discharged on a cane by day 78.
One patient, not a pattern. Multiple treatments were given at once.
Key findings
1Exercise therapy was started on day 3 of the ICU stay, beginning with range-of-motion and assisted sitting, progressing to standing on day 12, gait training on day 17, and a continuous 70 m walk by day 23. Mechanical ventilation was discontinued on day 24.
2The patient received plasma exchange switched to immunoadsorption (7 sessions), oral corticosteroids, tacrolimus, C5 complement inhibitors, steroid pulse therapy, and thymectomy in addition to exercise therapy. The authors state that the specific contribution of exercise therapy to functional improvement cannot be separated from these concurrent treatments.
3At discharge on day 78, the Functional Independence Measure motor subscore was 89 and the Quantitative Myasthenia Gravis score (excluding respiratory function) was stable at 3 without exacerbation.
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What it does not show
Single patient. This describes what happened to one woman, not what will happen to a group. Multiple treatments were given concurrently (plasma exchange, immunoadsorption, corticosteroids, tacrolimus, C5 complement inhibitors, steroid pulse therapy, thymectomy). The authors state the contribution of exercise therapy cannot be separated from these. No standardized criteria exist for initiating, progressing, or stopping exercise in myasthenic crisis, and the threshold for a clinically meaningful drop in grip strength or leg-elevation duration is undefined. Quality of life was not assessed. The patient was 40.4 kg with a BMI of 16.9, which may limit generalisability to patients with different body compositions. The authors note that accumulation of similar cases is needed to evaluate safety and efficacy.
Declared interests
The authors declared that no financial support was received for the work or its publication. No other conflicts of interest are stated.
The easy way to misread this
Do not read this as evidence that early ICU exercise therapy reverses myasthenic crisis. The patient also received plasma exchange, immunoadsorption, corticosteroids, tacrolimus, C5 complement inhibitors, and thymectomy. The authors themselves state that the specific contribution of exercise therapy to her functional improvement cannot be separated from these concurrent treatments.
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