1. A Case of Refractory Generalized Myasthenia Gravis Treated with Polypharmacy and Plasma Exchange
- Author
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Masanori Nakagawa, Chihiro Fujii, Yu Sato, Koushun Matsuo, Toshiki Mizuno, Tsuguru Hatta, Yuka Kawasaki Segawa, Kiyonori Miyata, Hiroshi Kado, and Rei Yasuda
- Subjects
Polypharmacy ,business.industry ,medicine.medical_treatment ,Insulin ,Therapeutic effect ,medicine.disease ,Dysphagia ,Myasthenia gravis ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Anesthesia ,Immunology ,medicine ,Plasmapheresis ,030212 general & internal medicine ,medicine.symptom ,Generalized myasthenia ,business ,030217 neurology & neurosurgery - Abstract
A 62-year-old man with myasthenia gravis (MG) was admitted with dyspnea, bulbar symptoms (dysphagia and dysarthria), and subsequent muscular weakness of the limbs. Results for anti-acetylcholine receptor antibody and muscle-specific kinase antibody were negative. We introduced periodic plasma exchange as a new therapeutic strategy. Once double-filtration plasmapheresis (DFPP) was adopted, effects became notable, but the response shortened over time. After stepwise increases in PSL up to 60 mg/day with insulin, the interval between DFPP was prolonged from 1 week to 2 weeks. DFPP was significantly beneficial in this case. Combining several effective methods can optimize therapeutic effects against refractory MG.
- Published
- 2016
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