Critical Matters Critical Care of Neuromuscular Disorders
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Jun 17, 2019 Dr. M. Kamran Athar, a neurointensivist at the Farber Institute for Neuroscience, dives deep into acute neuromuscular disorders like Guillain-Barré syndrome and myasthenia gravis. He discusses differential diagnostics and explains when to admit patients to the ICU based on respiratory and autonomic concerns. Unique insights include predicting respiratory failure in GBS and the role of immunotherapies versus corticosteroids. Athar also highlights the importance of patient dignity and effective decision-making in critical care.
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Dysautonomia Can Drive Severe GBS Complications
- Dysautonomia is common in GBS and can be life-threatening, causing wide blood pressure swings and arrhythmias.
- Monitor fluids, hemodynamics, and cardiac rhythms closely in ICU patients.
GBS Often Has Good Long-Term Recovery
- Despite severe presentation, most GBS patients recover; ~80% walk independently by six months and 60% fully recover motor strength by one year.
- A minority remain ventilator-dependent or have persistent deficits, so set realistic rehab expectations.
Myasthenia: Autoimmune NMJ Disorder
- Myasthenia gravis is an antibody-mediated disorder of the postsynaptic acetylcholine receptor with bimodal age distribution.
- Diagnosis uses clinical fatigability, AChR or MuSK antibodies, single-fiber EMG, and decremental RNS testing.
