Abstract
Objective
To evaluate the comparative efficacy of low dose daily versus alternate day plasma exchange in patients with severe myasthenia.
Methods
Thirty three patients with myasthenia gravis (Osserman's stage II b and III) were randomized to receive alternate day (n = 17) or daily low dose plasma exchange (n = 16). Plasma exchange were carried on each patient, number of exchanges varying subject to their requirements and 20-25 ml/kg plasma was removed during each session. Myasthenia gravis disease scale (MGDS) score was evaluated before and after the procedure. Time to wean off ventilator, removal of nasogastric tube and total duration of hospital stay were also assessed.
Results
There was no statistically significant difference between daily vs. alternate day group with regards to change in MGDS score, percentage change in MGDS score, and complication rates. A decreased hospital stay was observed in patients on daily plasma exchange which almost reached statistical significance.
Conclusion
We conclude from our study that daily and alternate day plasma exchange are similar in their efficacy and complication rates, however the daily schedule could be a preferred modality due to decreased hospital stay.
Article PDF
Similar content being viewed by others
References
Seybold ME (1999) Diagnosis of myasthenia gravis. In: Engel AG (ed.) Myasthenia gravis and myasthenic disorders. Oxford University Press, New York, pp. 146–66
Qureshi AI Suri MF (2000) Plasma exchange for treatment of myasthenia gravis : pathophysiologic basis and clinical experience. Review. Ther Apher 4(4):280–
Keesey JC (2002) Crisis in Mysthenia Gravis: an historical perspective Muscle Nerve (26):1–
Newsom-Davis J, Vincent A, Hawkey C, Pinching AJ, Ward CD, Wilson SG, (1978) Plasmapheresis for myasthenic gravis. N Engl J Med 298:456–57
Antozzi C, Gemma M, Berta E, Confalonieri P, Peluchetti D, Regi B, et al. (1991) A short plasma exchange protocol is effective in severe myasthenia gravis. J Neurol 238:103–07
Dau PC (1981) Response to plasmapheresis and immunosuppressive drug therapy in sixty myasthenia gravis patients. Ann NY Acad Sci 377:700–08
Kornfeld P, Ambiender EP, Binder AN, Goldberg J, Mitiag T, Papatestas AE, et.al. (1981). Plasmapheresis in refractory generalized myasthenia gravis. Arch Neurol 38:478–81
The utility of therapeutic plasmapheresis for neurological disorders. NIH Consensus development. (1986) JAMA 256(10):1333–337
Assessment of plasmapheresis report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology (1996). Neurology 47:840–43
Pinching AJ, Newsom-Davis J, Peters DK (1976). Remission of myasthenia gravis following plasma exchange. Lancet 2:1373–376
Gajdos P, Chevret S, Toyka K (2002). Plasma exchange for myasthenia gravis. Cochrane Database Syst Rev (4):CD002275
d'Empaire G, Hoaglin DC, Perlo VP, Pontoppidan H (1985). Efficacy of prethymectomy plasma exchange on postoperative respiratory function in myasthenia gravis. J Thorac Cardiovasc Surg 89:592–96
Gracey DR, Divertie MB, Howard FM Jr, Payne WS (1984). Postoperative respiratory care after transternal thymectomy in myasthenia gravis. A 3 year experience in 53 patients. Chest 86:67–1
Spence PA, Katz M, Morin JE (1984) Role of plasmapheresis in preparing myasthenic patients for thymectomy, initial results. Can J Surg 27:303–05
Yeh JH, Chiu HC (1999). Plasmapheresis in myasthenia gravis: A comparative study of daily versus alternately daily schedule. Acta Neuro Scand 90:147–51
Yeh JH, Chiu HC (1999). Double filtration plasmapheresis in myasthenia gravis–analysis of clinical efficacy and prognostic parameters. Acta Neurol Scand 5:305–
Yeh JH, Chiu HC (2000) Comparison between double filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patients with myasthenia gravis. J Neurol 247:51–13
Panda S, Goyal V, Singh S, Srivastav T, Behari M (2004) Myasthenic crisis — a retrospective study. Neurol India 4:453–
Fornasari PM, Riva G, Cosi V, Lombardi M, Piccolo G (1985) Short and long-term clinical effects of plasma exchange in 33 cases of myasthenia gravis. Int J Artif Organs 8:159–62
Seybold ME (1987) Plasmapheresis in myasthenia gravis. Ann NY Acad Sci 505:584–87
Plasmapheresis, acute Guillain Barre' Syndrome. The Guillain Barre' Syndrome Study Group (1985). Neurology 35:1096–104
Mantegazza R, Bruzzone E, Borroni V, Cornelio F, Marconi M, Peluchetti D, Reji B, et.al. (1987) Single donor plasma in therapeutic plasma exchange for myasthenia gravis. Int J Artif Organs 5:315–8
Gogovska L, Ljapcev R, Grcevska L, Polenakovic M, Popovska M, Stojkovski L (2003). Plasma exchange in the treatment of myasthenia gravis associated with thymoma. Int J Artif.organs 26:170–
Gajdos P, Chevret S, Chastang C, Clair B, Tranchant C (1997)Clinical trial of plasma exchange and high dose intravenous immunoglobulin in myasthenic gravis. Ann Neuro 41:789–96
Gajdos P, Chevret S, Clair B (1998) Plasma exchange and intravenous immunoglobulin in autoimmune myasthenia gravis. Ann NY Acad Sci 841;720
Roneger J, Rornborg M, Hermansen I, Vorstrup S (2001) Immunoglobulin treatment versus plasma exchange in patients with chronic moderate to severe myasthenia gravis. Artif Organs 12:967–3
Chiu HC, Chen WH, Yeh JH (2000) The six years experience of plasmapheresis in patients with myasthenic gravis. Ther Apher 4:291–.19
Rodnitzky RL, Goeken JA (1982). Complications of plasma exchange in neurological patients. Arch Neurol 39:350–4
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trikha, I., Singh, S., Goyal, V. et al. Comparative efficacy of low dose, daily versus alternate day plasma exchange in severe myasthenia gravis. J Neurol 254, 989–995 (2007). https://doi.org/10.1007/s00415-006-0235-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-006-0235-7