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Myasthenia Gravis

MG and plasma blood

07/17/2008

Question:

Dear Dr , I`m from Indonesia. My mom is 64 yrs. She is really in suffer because of MG for about 15 yrs, she takes 6 mestinon/day. Currently, she`s been diagnosed of thymus. Our Dr. will do a plasma blood transfer. Will this treatment, can cure her ? For how long & how many times this kind of treatment effective? Which is more effective, surgery or plasma blood transfer?  Thanks much.

Answer:

Surgery is thought to work by decreasing the body's immune response over time by taking out one of the organs involved in the immune system (the thymus). It is not a cure, and remains controversial. I quote people a 40-70% remission rate at 7-10 years. It is a big surgery and is not without risk, and should be performed only by someone who is experienced in the surgery and anatomy.

Pheresis is a great emergency treatment. Pheresis is the removal of some circulating blood component, either cells (cytapheresis) or some plasma solute (plasmapheresis). The goal is to remove the circulating substance directly responsible for the disease process (acetylcholine receptor antibodies). It involves the placement of a special catheter in your blood vessels through which your blood can be "filtered". It is usually performed over days for a complete course. It does have risks, including low calcium (hypocalcemia), allergic reactions, vasovagal reactions, low volume, low blood pressure, low white blood cell count or low platelets, and cardiac problems. Also patients can have complications related to the catheter placement, like bleeding and infection. It is not a procedure without risk, but if done safely and well, can be very effective It does not improve the long term disease, though, just removing antibodies circulating in the bloodstream at the time.

A great question to ask your mother's doctor is what kind of immunosuppressant is your mother being put on. Mestinon is symptomatic treatment, and pheresis is a temporary fix, and thymectomy is not a cure. By the time I am thinking about pheresis as a treatment, I am also looking at steroid or steroid-sparing immunosuppressant therapies (like azathioprine).

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati