Gregory Atafo1, Aliu Yakubu2, Moses Effiong3, Olorungbami Anifalaje4, Chukwuma Nwaze5, Chioma Muotoh6, Favour Ezem7, Glory Adebajo8, Meagan King9
1Medical University of the Americas, St. Kitts and Nevis, 2Neurology, University of Texas Medical Branch, 3Clinical Research Centre, Ninewells Hospital, NHS Tayside, Dundee, UK, 4University Hospital Wishaw, NHS Lanarkshire, Scotland, UK, 5Lagos University Teaching Hospital, Lagos, Nigeria., 6University College Hospital, Ibadan, Nigeria, 7University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu state, 8Federal Medical Centre, Abeokuta, Nigeria, 9John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, US
Objective:
To identify and synthesize predictors of myasthenic crisis in patients with myasthenia gravis (MG) through a scoping review of the existing literature.
Background:
Myasthenic crisis is a life-threatening complication of MG characterized by respiratory failure requiring ventilatory support. Identifying reliable predictors is essential for risk stratification, prevention, and optimized perioperative and acute management.
Design/Methods:
A scoping review was conducted following PRISMA-ScR guidelines. Electronic databases were systematically searched for studies reporting predictors or risk factors for myasthenic crisis. Retrospective and prospective cohorts, case-control studies, and registry analyses were included. Data on study characteristics, patient demographics, risk factors across multiple domains, and outcomes were extracted and synthesized qualitatively.
Results:
Thirty-nine studies published between 1997 and 2025 were included (31 retrospective cohorts, 5 case-control, 2 prospective, 1 registry-based), encompassing predominantly Asian cohorts. Consistent predictors of crisis included higher disease severity (MGFA Class ≥III or equivalent Osserman stage), thymoma, preoperative bulbar symptoms, history of prior crisis , reduced preoperative pulmonary function (%FVC or %FEV1 thresholds), and higher preoperative pyridostigmine doses. Infection (especially respiratory) was the leading precipitant. Older age, MuSK-antibody positivity, and select biomarkers (e.g., elevated platelet-to-lymphocyte ratio, lactate) were associated with disease in multiple studies. Perioperative factors such as advanced Masaoka stage and incomplete resection also increased the risk. Mortality varied widely (2.6–30%) across contexts, with favorable outcomes in specialized centers that used immunomodulation.
Conclusions:
This scoping review highlights robust clinical predictors of myasthenic crisis, particularly disease severity, bulbar involvement, prior crisis, thymoma, and impaired respiratory reserve. These findings support improved risk assessment and targeted preventive strategies, though prospective, multi-center studies are needed to enhance generalizability and develop validated predictive models
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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