Plasma filtration removes antibodies and other circulating factors and has short term benefit (4-6 weeks). A plasma volume of 1.5-2 litres is exchanged 3-5 times over a 6-8 day period. The technique is expensive and carries risks (hypotension, metabolic disturbance and thrombo-embolism). It is used to stabilise refractory cases and prior to thymectomy in severe disease. Immunoglobulin (IVIG)
May be used in place of plasmapheresis at a dose of 400 mg per Kg intravenously daily for 5 days. Mechanism may act by blocking ACh receptors. A positive response (75% of patients) lasts for 2-3 months. Treatment is expensive and long term effects and complications unknown.
Anticholinesterases should not be required throughout the whole illness. When immunological control of the disease is obtained, these drugs may be stopped.
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