Summary
Plasma exchange has been reported to be a successful therapeutic procedure for the treatment of severely compromised myasthenic patients, but the optimal regimen in terms of costs or clinical benefit has not so far been determined. We have investigated the efficacy of a short plasmapheresis protocol of two exchanges 1 day apart in a series of 70 patients with severe forms of myasthenia gravis. Patients were evaluated before and 7 days after the first exchange. A positive outcome was observed in 70% of the plasma exchange cycles performed. Disease severity did not seem to be a negative prognostic factor for the efficacy of this short protocol, which was well tolerated by patients. In only 1 case were major side-effects observed. In spite of its short duration, the exchange treatment plus concomitant immunosuppressive drug therapy was not followed by early clinical deterioration.
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Behan PO, Shakir RA, Simpson JA, Burnett AK, Allan TL, Haase G (1979) Plasma-exchange combined with immunosuppressive therapy in myasthenia gravis. Lancet II:438–440
Carter B, Harrison R, Lunt GG, Behan PO, Simpson JA (1980) Antiacetylcholine receptor antibody titres in the sera of myasthenia patients treated with plasma exchange combined with immunosuppressive therapy. J Neurol Neurosurg Psychiatry 43:397–402
Consensus Conference (1986) The utility of therapeutic plasmapheresis for neurological disorders. JAMA 256:1333–1337
Dau PC (1980) Plasmapheresis therapy in myasthenia gravis. Muscle Nerve 3:468–482
Dau PC (1981) Response to plasmapheresis and immunosuppressive drug therapy in sixty myasthenia gravis patients. Ann NY Acad Sci 377:700–708
Dau PC (1984) Plasmapheresis. Therapeutic or experimental procedure. Arch Neurol 41:647–653
Dau PC, Lindstrom JM, Cassel CK, Denys EH, Shev EE, Spitler LE (1977) Plasmapheresis and immunosuppressive drug therapy in myasthenia gravis. N Engl J Med 297:1134–1140
Gotti C, Mantegazza R, Clementi F (1984) New antigen for antibody detection in myasthenia gravis. Neurology 34:374–377
Hawkey CJ, Newsom-Davis J, Vincent A (1981) Plasma exchange and immunosuppressive drug treatment in myasthenia gravis: no evidence for synergy. J Neurol Neurosurg Psychiatry 44:469–475
Huestis DW (1986) Complications of therapeutic apheresis. In: Valbonesi M, Pineda AA, Biggs JC (eds) Therapeutic hemapheresis. Wichtig, Milan, pp 179–186
Keesey J, Buffkin D, Kebo D, Winston O, Herrmann C (1981) Plasma exchange alone as therapy for myasthenia gravis. Ann NY Acad Sci 377:729–740
Kornfeld P, Ambinder AP, Papatestas AE, Bender AN, Genkins G (1979) Plasmapheresis in myasthenia gravis: controlled study. Lancet I:629
Kornfeld P, Ambinder EP, Mittag T, Bender AN, Papatestas AE, Goldberg J, Genkins G (1981) Plasmapheresis in refractory generalized myasthenia gravis. Arch Neurol 38:478–481
Lisak RP (1984) Plasma exchange in neurological disease. Arch Neurol 41:654–657
Mantegazza R, Bruzzone E, Regi B, Peluchetti D, Marconi M, Sirchia G, Borroni V, Cornelio F (1987) Single donor plasma in therapeutic plasma exchange in myasthenia gravis. Int J Artif Organs 5:315–318
Mantegazza R, Antozzi C, Peluchetti D, Sghirlanzoni A, Cornelio F (1988) Azathioprine as a single drug or in combination with steroids in the treatment of myasthenia gravis. J Neurol 235:449–453
Marconi M, Mercuriali F, Sirchia G (1981) Approaching plasma exchange mathematically. Int J Artif Organs 4:294–299
Miller RG, Milner-Brown HS, Dau PC (1981) Antibody-negative acquired myasthenia gravis: successful therapy with plasma exchange. Muscle Nerve 4:255
Milner-Brown HS, Miller RG (1982) Time course of improved neuromuscular function following plasma exchange alone and plasma exchange with prednisone/azathioprine in myasthenia gravis. J Neurol Sci 57:357–368
Newsom-Davis J, Vincent A (1979) Combined plasma exchange and immunosuppression in myasthenia gravis. Lancet II:688
Newsom-Davis J, Pinching AJ, Vincent A, Wilson SG (1978) Function of circulating antibody to acetylcholine receptor in myasthenia gravis: investigation by plasma exchange. Neurology 28:266–272
Newsom-Davis J, Vincent A, Wilson SG, Ward CD (1979) Long-term effects of repeated plasma exchange in myasthenia gravis. Lancet II:464–468
Olarte MR, Schoenfeldt RS, Penn AS, Lovelace RE, Rowland LP (1981) Effect of plasmapheresis in myasthenia gravis 1978–1980. Ann NY Acad Sci 377:725–728
Osserman KE, Jenkins G (1971) Studies in myasthenia gravis: review of a twenty years experience in over 1200 patients. Mt Sinai J Med 38:497–537
Perlo VP, Shahani BT, Huggins CE, Hunt J, Kosinski K, Potts F (1981) Effect of plasmapheresis in myasthenia gravis. Ann NY Acad Sci 377:709–724
Pinching AJ, Peters DK, Newsom-Davis J (1976) Remission of myasthenia gravis following plasma-exchange. Lancet II:1373–1376
Sghirlanzoni A, Peluchetti D, Mantegazza R, Fiacchino F, Cornelio F (1984) Myasthenia gravis: prolonged treatment with steroids. Neurology 34:170–174
Thorlacius S, Aarli JA, Jacobsen H, Halvorsen K (1985) Plasma exchange in myasthenia gravis: clinical effect. Acta Neurol Scand 72:464–468
Tindall RSA, Rollins J (1986) Apheresis in the treatment of myasthenia gravis. In: Valbonesi M, Pineda AA, Biggs JC (eds) Therapeutic hemapheresis. Wichtig, Milan, pp 43–52
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Antozzi, C., Gemma, M., Regi, B. et al. A short plasma exchange protocol is effective in severe myasthenia gravis. J Neurol 238, 103–107 (1991). https://doi.org/10.1007/BF00315690
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DOI: https://doi.org/10.1007/BF00315690