The May 2025 issue of Emergency Medicine Practice focused on the Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis. The table below is a comparison of key points in the ED management of these diseases. For more on this topic, read the article here.
Neuro Emergencies Side-by-Side: Parkinson’s, MG, and MS
| Domain | Parkinson Disease | Myasthenia Gravis | Multiple Sclerosis |
|---|---|---|---|
| Typical ED Presentation | Falls, trauma, confusion, chest pain as comorbidity | Fatigable weakness, diplopia, ptosis, SOB | Vision loss (optic neuritis), motor/sensory flare, fatigue |
| Primary ED Concern | Missed medication doses, fall risk | Ventilatory failure, risk of sudden decompensation | New flare vs pseudoflare from fever or infection |
| Key Medication Issues | Carbidopa/levodopa must be given on schedule | Avoid exacerbating meds (e.g., beta blockers, macrolides) | Steroids for true flare; beware baclofen withdrawal |
| Respiratory Risk | Low unless severe rigidity impairs breathing | High; ventilatory failure can be sudden and subtle | Low in typical flare, but baclofen withdrawal is emergent |
| Intubation Considerations | Continue meds even if intubated; no paralytic contraindicated | Avoid rocuronium; use succinylcholine carefully or avoid paralytics | Standard agents acceptable; no known contraindications |
| Common Triggers | Missed meds, infection, dopamine blockers | Infection, new meds, stress | Fever, infection, baclofen pump malfunction |
| Diagnostic Strategy | Clinical diagnosis; exclude mimics like stroke | NIF testing, single breath count, rule out triggers | MRI and/or LP for flare confirmation; clinical judgment |
| Disposition Considerations | Safe discharge if meds given and support in place | Admit if ventilatory status uncertain or crisis suspected | Admit if unable to tolerate PO steroids or unclear dx |
| Role of Neurology Consult | Helpful for med reconciliation, safe discharge planning | Often needed for management guidance, IVIG, or plasmapheresis | Essential for disease-modifying therapy coordination |
Reference:
Rose J, Burmon CW, Rozehnal J. Emergency department management of patients with complications of chronic neurologic disease: Parkinson disease, myasthenia gravis, and multiple sclerosis. Emerg Med Pract. 2025 May 1;27(5):1-24. Epub 2025 May 1. PMID: 40272915.
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
