[Plasmapheresis and immunoglobulin therapy]

Plasmapheresis (PP) and intravenous immunoglobulin (IVIG) are both effective for treatment of crisis and acute exacerbation of myasthenia gravis. The 1(st) clinical problem is that effect of both treatments usually lasts for only 2-3 weeks. Additional immunosuppressive treatments may be necessary for prevention of the relapse. The 2(nd) problem is adverse effects and complications associated with each treatment. Hypotension, including shock, thromboembolism, and opportunistic infections are major adverse events of PP. Awareness of these complications and careful practice should be solutions. IVIG complicates less adverse effects than PP. The cost of each treatment, which is expensive particularly in IVIG use, may become the 3(rd) problem. It should be important to clarify the appropriate number of PP and the dose of IVIG to improve myasthenic crisis.