Role of plasmapheresis in treatment of myasthenia gravis

ABSTRACT

We followed up the results of treatment with plasmapheresis in 21 patients of generalized myasthenia gravis [MG]. These patients were of IIA, IIB and IV stages according to Osserman classification. They were treated with plasmapheresis because of being failed to achieve a sustained satisfactory improvement with an adequate courses of anticholinesterases prednisone and azathioprine. They were clinically evaluated before the start of plasmapheresis and on the 7[th] day after the last exchange and were followed up for 6 months later. Good improvement, with shift in Osserman stage was obtained in 13 [61.9%] patients, three of them were symptomless at the end of the therapy. Mild improvement was observed in six patients [28.57%]. The response was transient extending only for 2 - 4 weeks in six patients [28.57%] and for 2 - 4 months in seven patients [33.3%], while a prolonged remission of more than six months was observed in other six patients [28.57%]. The response to plasmapheresis was not altered by sex, duration of illness or initial clinical state before exchange. The serum levels of immunoglobulin A, M and G were reduced in all patients after plasmapheresis. The patients who achieved marked improvement [grade 2] had had the lowest serum levels of immunoglobulins [Igs] before and after plasmapheresis