HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

NEUROMUSCULAR JUNCTION DISEASES

Demet Bölükbaşı

Ankara Bilkent City Hospital, Department of Intensive Care, Ankara, Türkiye

Bölükbaşı D. Neuromuscular Junction Diseases. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.189-197.

ABSTRACT

Most neuromuscular junction (NMJ) diseases are acquired. Common NMJ diseases include myasthenia gravis (MG), Lambert-Eaten myasthenic syndrome (LEMS), and botulism. Among these, the most common disease is MG, which has an autoimmune basis and is mediated by antibodies targeted against postsynaptic receptors. MG is clinically divided into ocular and generalized MG types. In LEMS, presynaptic calcium channels are affected. Patients with LEMS should be screened for malignancy (mostly small-cell lung cancer) because it may accompany malignancy. However, LEMS may also manifest as an autoimmune disease. Botulism occurs when neurotoxins produced by Clostridium botulinum inhibit presynaptic receptors. Botulinum toxins are taken into the body through food, wounds, or medical toxin treatment. In NMJ diseases, respiratory failure may develop due to increased muscle weakness and atelectasis because of impaired secretion/excretion. These patients may need invasive mechanical ventilation, and postoperative patients and pregnant women may need close intensive care follow-up.

Keywords: Neuromuscular junction; Myasthenia gravis; Lambert-eaton myasthenic syndrome; Botulism; Critical care

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