PLASMAPHERESIS IN SEVERE FORMS OF MYASTHENIA-GRAVIS

In this study we introduce a new combination treatment of plasma excha nge (PE) and high daily doses of prednisone for severe forms of myasth enia gravis (MG). The clinical efficacy of the combined therapy has be en tested in 18 patients suffering from severe forms of MG. The protoc ol included 5 sessions of PE, performed in a range of 15 days, 1 sessi on every 3 days, with concurrent administration of oral prednisone (1 mg/kg of body weight), starting at the first session of PE and given d aily for at least 3 months. At the end of the entire cycle of PE, almo st complete recovery (more than 90% of the initial clinical score) was obtained in 8 of 18 patients while an improvement between 60 and 90% of the initial score was achieved in 9 of 18 patients. An early improv ement was noted 24 h after the beginning of plasmapheresis in 11 of 18 patients. No recurrence of symptoms was reported after 36 months of f ollow-up for 17 patients. The administration of steroid therapy was ne ver followed by an early exacerbation of myasthenic symptoms as report ed when it is administered in the absence of concomitant PE. According to our results, we can conclude that high doses of oral prednisone th erapy in simultaneous association with PE lead to successful control o f severe forms of MG, significantly superior to the therapeutic strate gies until now adopted and reported in literature.