Plasmapheresis in myasthenia gravis

Plasmapharesis is a therapeutic option in myasthenia gravis:

• plasma exchange does no better than immunosuppression in reducing circulating levels of the anti-AChR antibody and in inducing clinical improvement
• main role is in helping to relieve a myasthenic crisis, in preparing patients for a thymectomy and post-operatively, and in covering the increased weakness that may occur when corticosteroid treatment is begun (1)
• plasma exchange is usually followed by 3-5 weeks of improved strength.
• may be needed repeatedly in patients with chronic and severe weakness while immunosuppressive treatment becomes effective

IV immunoglobulin (IVIg) or plasmapheresis can be used in severe disease and exacerbations, but plasmapheresis is probably better for true myasthenic crises

• plasmapheresis may produce a more rapid response, but IVIg is less expensive and may have fewer complications.

Reference:

• Jeffrey M. Statland, Emma Ciafaloni. Myasthenia gravis: Five new things Neurol Clin Pract. 2013 April; 3(2): 126-133.