Poster 251: Improved Swallowing after a Trial of Electric Stimulation in Patient with Myasthenia Gravis: A Case Report

Setting: Acute inpatient rehabilitation center. Patient: A 75-year-old woman with myasthenia gravis (MG). Case Description: The patient had a 3-month history of progressively worsening weakness of primarily bulbar muscles and was diagnosed with MG via positive anti-acetylcholine receptor antibodies and a positive Tensilon test. Initial fiberoptic endoscopic evaluation of swallowing with sensory testing (FEEST) revealed severe oropharyngeal phase dysphagia characterized by delayed swallow initiation, pharyngeal pooling with residuals, and penetration with silent aspiration of puree and honey-thick liquids. Based on these results, her diet was changed to nothing by mouth and a percutaneous endoscopic gastrostomy tube was placed. A trial of electric stimulation was initiated 5 times weekly with a fatigue precaution and for a reduced time interval (30−45min rather than the typical 60min). Assessment/Results: Repeat FEEST after only 6 sessions showed improvement in swallowing function. She was able to clear residuals with multiple swallows. Coordination and swallow initiation speed increased enough to initiate oral feeding trials with the speech therapist. Discussion: MG is clinically characterized by pathologic fatigue with repetitive muscular contraction. While it may seem counterintuitive to apply electric stimulation to improve muscular function, the patient’s dysphagia improved after 6 sessions and continued to improve over the following several months. She was advanced to and tolerated a dysphagia diet after only 1 month of treatment. Conclusions: While some of the patient’s improvements in dysphagia may have been the natural remission of her disease, electric stimulation (with caution to avoid fatigue) as a treatment modality for dysphagia in MG patients shows promise. Experimental studies should be conducted to better assess the mechanism of action and level of efficacy.