[Plasmapheresis in patients with myasthenia gravis].

This review describes the three ways of plasmapheresis in patients with myasthenia gravis: plasma exchange (PE), double filtration plasmapheresis (DFP) and immunoadsorption (IA). DFP or IA was used for selective removal of antibodies to acetylcholine receptor without replacement of albumin. Plasmapheresis is indicated in patients with myasthenic crisis or before thymectomy. Comparative studies between plasmapheresis and high-dose of intravenous immunoglobulin (IVIG) showed similar transient improvement on myasthenic symptoms up to 4 to 8 weeks. Rapid improvement was obtained by plasmapheresis. In Japan, nation-wide randomized open clinical trial of IVIG is now going on to evaluate the clinical effectiveness of this therapy on moderately involved generalized myasthenia gravis. It is aimed to obtain the license of the government for the usage of this therapy.