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Myasthenia gravis exacerbation in association with antibody overshoot following plasmapheresis
Author(s) -
Ching Jason,
Richards Danielle,
Lewis Richard A.,
Li Yuebing
Publication year - 2021
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.27341
Subject(s) - myasthenia gravis , plasmapheresis , medicine , exacerbation , overshoot (microwave communication) , acetylcholine receptor , titer , antibody , gastroenterology , immunology , receptor , electrical engineering , engineering
/Aim Antibody overshoot following therapeutic plasmapheresis (PLEX) is defined by subsequent increase in antibody to levels exceeding those prior to removal. It has been infrequently described in the past, and its influence on the clinical course of myasthenia gravis (MG) remains unclear. Methods This was a retrospective analysis of five patients with generalized MG treated with PLEX. Results All five patients possessed antibodies against acetylcholine receptor (AChR‐Ab). After undergoing 3 to 12 PLEX treatment sessions, AChR‐Ab titer increased to a median of 1292% of the baseline level. The median interval from the last PLEX session to peak AChR‐Ab detection was 6 wk. In four patients, AChR‐Ab overshoot was associated with a clinical deterioration. Discussion The AChR‐Ab overshoot may occur following PLEX. In patients who deteriorate following PLEX treatment, the presence of antibody overshoot may serve as additional guidance for treatment adjustment.