RESPECTIVE INDICATIONS OF PLASMA-EXCHANGE AND HIGH-DOSE IMMUNOGLOBULINS IN POLYRADICULONEVRITIS AND MYASTHENIA-GRAVIS

The main purpose of plasma exchange is to remove toxic substances. The mechanisms involved appear to be complex. The primary aim of immunogl obulins is to compensate for immunodeficiency, but when given intraven ously at high doses, immunoglobulins can also have unexpected immunomo dulation effects. Routine therapeutic use of these methods raises the problem of cost and potential morbidity. Two therapeutic trials have d emonstrated that plasma exchange in Guillain-Barre syndrome improves o utcome when given early. In chronic polyradiculonevritis, plasma excha nge and intravenous immunoglobulins have been shown to be equally effe ctive although plasma exchange would give less satisfactory results in patients with polyradiculonevritis and monoclonal IgG. The effect of intravenous immunoglobulins is being evaluated. Plasma exchange has be come the gold standard for acute crisis of myasthenia gravis. Recent r esults suggest that intravenous immunoglobulins could be equally effec tive in these diseases. Though useful therapeutic tools, the respectiv e indications and optimal doses for these methods remains to be define d.