The treatment of severe forms of myasthenia gravis

Cesare Iani, Maria Caramia, Massimo Morosetti, Marco Loberti, Maria Giuseppina Palmieri, Carlo Meloni, Massimo Taccone Gallucci, Carlo Umberto Casciani, Giorgio Bernardi

Research output: Contribution to journalArticlepeer-review

Abstract

In this study we introduced and tested the clinical efficacy of a combined treatment based on the association of plasma exchange (PE) with high daily doses of prednisone in 18 patients with severe forms of myasthenia gravis (MG). A myasthenic score based on strength and resistance was evaluated in each patient in basal condition and during the treatment. The study design included 5 sessions of PE, performed within a period of 15 days, 1 session every 3 days, associated with administration of oral prednisone (1 mg/kg of body weight), which began at the same time as the first session and was continued following a daily schedule for at least three months. A significant improvement was obtained from the start of the therapy, with a reduction of the myasthenic score from 26.56 to 11.44 by day 10 and with further reduction after PE interruption. An early improvement, recorded within 24-48 hours of the beginning of the study design, was observed in 11/18. The administration of steroid therapy was never followed by a worsening of myasthenic symptoms (as reported when it is administered in the absence of concomitant PE). No recurrence of symptoms was reported after 29 months' follow-up. This type of therapeutic association was generally well tolerated and no unwanted side effects were observed. According to our results we can conclude that medium-high doses of oral prednisone in simultaneous association with PE lead to a successful control of severe forms of MG and may be considered a valid therapeutic strategy.

Original languageEnglish
Pages (from-to)231-237
Number of pages7
JournalFunctional Neurology
Volume13
Issue number3
Publication statusPublished - Jul 1998

Keywords

  • Myasthenia gravis
  • Myasthenic crisis
  • Plasma exchange
  • Steroids and plasmapheresis
  • Steroids in myasthenia

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

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