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Sunday, September 21, 2014
Plasmapheresis did not work
My mum, 73 years old was diagnosed with Myastheinia Gravis five months ago. Her problem started two weeks after she went through a major divericulitus surgery about eight months ago. Prior to that she did not have any MG symptom. Recently she did Plasmapherosis but it only helped her slightly and for three days and quickly double vision was back, one of the eyes was closed again, fatigueness, etc. My impression is that Plasmapherosis is usually effective for about three or more weeks. Why on her case this treatment was not as effective? By the way she did IVIG about two months ago but did not react positively and was advised not to do it again. She is currently on 6 Mestinon on a day and 2 tablets of Azatioprine.
Treatment responses of MG is difficult disease to predict. Plasmapheresis and IVIG work quickly if they are going to work at all. Prednisone acts fairly quickly (over weeks) but has many side-effects. Other immunosupressing drugs (Imuran, Cellcept) are often used. It is likely that your mother will need a combination of these and other treatments to control her disease. Unfortunately, it impossible to tell which combination it will be. (I should note that often we choose medications based on the patient's other medical conditions -- trying to avoid side-effects.)
John G Quinlan, MD
Professor of Neurology
College of Medicine
University of Cincinnati