The course of MS is unpredictable. A few categories of progression have been identified. Etiology possibly autoimmune. Myasthenic Crisis Myasthenic crisis- sudden exacerbation of myasthenic symptoms, usual precipitating event is infection, although in some cases there is no evident precipitator. Even with medication, symptoms progress and often require respiratory support.
Medications are frequently ineffective for a few days.
They are withheld for a few days then resumed. As motor strength and function resume, the patient is weaned from the ventilator. Cholinergic crisis- event precipitated by toxic levels of anticholinesterase drugs. Basically a problem of over medication. Presentation is abdominal cramping, diarrhea, increased respiratory secretions, muscle twitching and cramping, weakness.