scholarly journals Therapeutic plasma exchange in neuroimmune diseases. Rehabilitation in myasthenia gravis patients treated with apheresis procedures

2021 ◽  
Vol 12 (Vol.12, no.1) ◽  
pp. 103-106
Author(s):  
Maria-Gabriela CATANĂ ◽  
Mihai SAVA ◽  
Corina ROMAN-FILIP
Keyword(s):  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Cost Effective ◽  
Therapeutic Plasma Exchange ◽  
Therapeutic Modality ◽  
Myasthenic Crisis ◽  
Class Iii ◽  
Extracorporeal Blood Purification

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique which removes large molecular weight particles, like autoantibodies, from plasma. Double filtration plasmapheresis (DFPP) is a newer technique in which plasma is not entirely removed, only the antibodies, using special filters. Myasthenia gravis (MG) is a well-known autoimmune disease characterized by antibodies against postsynaptic nicotinic acetylcholine receptors and fluctuating weakness, sometimes life-threatening. TPE is a therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence and in the category I of American society for apheresis. There are no adequate randomized control trial, but many cases report short-term benefit from plasma exchange in MG especially MGC. We analyzed the cases of neuroimmune disorders that were presented to our Emergency Care Unit between 2012-2020 and we concluded that good acceptance of procedure (TPE/DFPP) was observed in 72% of patients. TPE is cost-effective rapid therapy for myasthenic crisis and progressive myasthenia gravis. It reduces ICU stays and improves outcome.All in all recent studies show that the combination of rehabilitation and other forms of treatment, appropriately selected activities contribute to alleviating the symptoms of the disease, improving physical fitness, increasing muscle strength, and thus improving the quality of life. Keywords: therapeutic plasma exchange, plasmapheresis, neuroimmune disorders,rehabilitation,

scholarly journals Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1234 ◽  
Author(s):  
Osman Sinanović ◽  
Sanela Zukić ◽  
Adnan Burina ◽  
Nermina Pirić ◽  
Renata Hodžić ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Clinical Response ◽  
Plasma Exchange ◽  
Neurological Diseases ◽  
Therapeutic Plasma Exchange ◽  
Motor Neuropathy ◽  
Extracorporeal Blood Purification ◽  
Clinical Center ◽  
Plasma Factor ◽  
Neurological Patients

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016.   Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

Myasthenia Gravis Patient Presenting for Ureteroscopy

2018 ◽  
pp. 287-294
Author(s):  
Theresa J. Barnes ◽  
Amanda Moraska Benson ◽  
Ashish K. Khanna
Keyword(s):  
Myasthenia Gravis ◽  
Muscle Weakness ◽  
Respiratory Insufficiency ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Neuromuscular Blocking ◽  
Myasthenic Crisis ◽  
Respiratory Impairment ◽  
Skeletal Muscle Weakness ◽  
Autoimmune Condition

Myasthenia gravis (MG) is an autoimmune condition, most commonly affecting middle-aged women and older males, caused by antibody-mediated attack of the postsynaptic nicotinic acetylcholine receptors at the neuromuscular junction. The resulting skeletal muscle weakness can be highly variable, ranging from fatigue of ocular muscles only to significant respiratory impairment with peripheral muscle weakness. MG has multiple important implications for anesthesiologists. This surgical case explores the pathophysiology of MG, common treatments, preoperative anesthetic assessment, intraoperative considerations, implications for anesthetic drug interactions, predictors of postoperative respiratory insufficiency, and a review of postoperative concerns and complications. Topics covered include myasthenic crisis, postoperative respiratory insufficiency, anticholinesterase, neuromuscular blocking drugs, thymectomy, and extubation criteria.

scholarly journals Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

2004 ◽  
Vol 62 (2b) ◽  
pp. 391-395 ◽  
Author(s):  
Rosana Carandina-Maffeis ◽  
Anamarli Nucci ◽  
José F.C. Marques Jr ◽  
Eduardo G. Roveri ◽  
Beatriz H.M. Pfeilsticker ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Mortality Rates ◽  
Motor Deficit ◽  
Myasthenic Crisis ◽  
Clinical Hospital ◽  
The Mean ◽  
Mean Time

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

scholarly journals Microbial Technologies Employed for Biodegradation of Neonicotinoids in the Agroecosystem

2021 ◽  
Vol 12 ◽  
Author(s):  
Sajjad Ahmad ◽  
Dongming Cui ◽  
Guohua Zhong ◽  
Jie Liu
Keyword(s):  
Nicotinic Acetylcholine Receptors ◽  
Metabolic Pathways ◽  
Acetylcholine Receptors ◽  
Cost Effective ◽  
Toxic Substances ◽  
Nervous Stimulation ◽  
The World ◽  
Synthetic Pesticides ◽  
Immobilization Techniques ◽  
Biological Methods

Neonicotinoids are synthetic pesticides widely used for the control of various pests in agriculture throughout the world. They mainly attack the nicotinic acetylcholine receptors, generate nervous stimulation, receptor clot, paralysis and finally cause death. They are low volatile, highly soluble and have a long half-life in soil and water. Due to their extensive use, the environmental residues have immensely increased in the last two decades and caused many hazardous effects on non-target organisms, including humans. Hence, for the protection of the environment and diversity of living organism’s the degradation of neonicotinoids has received widespread attention. Compared to the other methods, biological methods are considered cost-effective, eco-friendly and most efficient. In particular, the use of microbial species makes the degradation of xenobiotics more accessible fast and active due to their smaller size. Since this degradation also converts xenobiotics into less toxic substances, the various metabolic pathways for the microbial degradation of neonicotinoids have been systematically discussed. Additionally, different enzymes, genes, plasmids and proteins are also investigated here. At last, this review highlights the implementation of innovative tools, databases, multi-omics strategies and immobilization techniques of microbial cells to detect and degrade neonicotinoids in the environment.

Other Proven and Putative Autoimmune Disorders of the Peripheral Nervous System

2017 ◽  
Author(s):  
Doris G. Leung
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Autoimmune Disorder ◽  
Synaptic Proteins ◽  
Disease Treatment ◽  
Nicotinic Acetylcholine ◽  
System P ◽  
Presynaptic Calcium

Myasthenia gravis is in most cases an autoimmune disorder of the neuromuscular junction in which antibodies are directed at nicotinic acetylcholine receptors or other synaptic proteins, such as the MusK protein that is involved in the formation of the formation and maturation of the motor endplate. Less commonly, myasthenia gravis can result from antibodies directed to presynaptic calcium channels as a side effect of paraneoplastic antibodies (Lambert-Eaton syndrome) or from a developmental paucity of acetylcholine receptors in the neonatal form of the disease. Treatment is usually a combination of aceetylcoholinesterase inhibitors such as pyridostigmine to prolong the life of acetylcholine released at the neuromuscular junction and/or drugs such as corticosteroids aimed at reducing inflammation.

scholarly journals Thymic B lymphocyte clones from patients with myasthenia gravis secrete monoclonal striational autoantibodies reacting with myosin, alpha actinin, or actin.

1986 ◽  
Vol 164 (4) ◽  
pp. 1043-1059 ◽  
Author(s):  
C L Williams ◽  
V A Lennon
Keyword(s):  
Skeletal Muscle ◽  
Epithelial Cells ◽  
Myasthenia Gravis ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
B Lymphocyte ◽  
High Yield ◽  
Thymic Epithelial Cells ◽  
Anchoring Proteins ◽  
Mucosal Cells

Striational autoantibodies (StrAb), which react with elements of skeletal muscle cross-striations, occur frequently in patients with thymoma associated with myasthenia gravis (MG). Dissociated thymic lymphocytes from 22 of 72 MG patients secreted StrAb when cultured with PWM. A high yield of EBV-transformed B cell lines was established from thymus, thymoma, and peripheral blood of seven patients with MG, but clones secreting StrAb arose only from the three patients who had StrAb in their sera. The monoclonal StrAb bound to A bands or I bands in skeletal muscle of human, rat, and frog. One bound to mitochondria in addition to myofibrillar I bands. None bound to nuclei, smooth muscle, or gastric mucosal cells. In immunoblot analyses and ELISAs the monoclonal StrAb bound to muscle and nonmuscle isotypes of myosin, alpha actinin, and/or actin. All bound to contractile proteins common to thymus and muscle, and one selectively immunostained epithelial cells of the thymic medulla. From these antigenic specificities we suggest that StrAb might arise as an immune response directed against the cytoskeletal anchoring proteins associated with nicotinic acetylcholine receptors in thymic epithelial cells undergoing neoplastic transformation to thymoma.

scholarly journals Specific features of anesthesia in patients with myasthenia gravis

2016 ◽  
Vol 69 (9-10) ◽  
pp. 305-311
Author(s):  
Ivana Spasojevic ◽  
Danica Hajdukovic ◽  
Milena Komarcevic ◽  
Stanislava Petrovic ◽  
Jelena Jovanovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Myasthenia Gravis ◽  
Nicotinic Acetylcholine Receptors ◽  
Acetylcholine Receptors ◽  
Surgical Interventions ◽  
Different Types ◽  
Increased Sensitivity ◽  
Tensilon Test

Introduction. Myasthenia gravis is an autoimmune disease caused by antibodies leading to the destruction of nicotinic acetylcholine receptors on the neuromuscular junction. It is characterized by muscle weakness that gets aggravated with physical activity and improves at rest. Myasthenia Gravis Foundation of America made the clinical classification of Myasthenia gravis which is still in use today. ?Tensilon test? is still the gold standard for the diagnosis of Myasthenia gravis. In addition to this test repeated muscular stimulation can be used as well as the analysis of specific autoantibodies. Treatment of Myasthenia Gravis. In conservative treatment of Mysthenia gravis anticholinesterases, immunosuppressants and plasmapheresis can be used. If conservative treatment does not lead to the desired remission, surgical treatment is indicated. The most accepted indication for thymectomy is the presence of thymoma with generalized form of Myasthenia gravis in adults. How to Distinguish Myasthenic From Cholinergic Crisis. The following is important to make a difference between these two crises: knowledge of the events that preceded the crisis, the size of pupils as well as the presence of muscarinic signs and tensilon test. Specific Features of Anesthesia in Patients with Myasthenia Gravis. Mechanism of the disease development is the reason for the increased sensitivity or resistance of these patients to certain types of drugs used in anesthesia. Protocol of Perioperative Anesthesia in Patients with Myasthenia Gravis. Based on 35 years of experience in the surgical treatment of patients with Myasthenia gravis anesthesiologists at the Department of Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, made the protocol of anesthesia and perioperative treatment for these patients. Conclusion. Anesthesiologists may have to deal with a patient with myasthenia gravis in different types of surgical interventions. The protocol for anesthesia and perioperative management of these patients herewith presented may greatly help them in their clinical practice.

scholarly journals Colon Adenoma Implicating Myasthenia Gravis: A Case Report of a Patient with Postcolectomy Complications

2016 ◽  
Vol 2016 ◽  
pp. 1-2
Author(s):  
Y. Papachatzakis ◽  
E. Tseliou ◽  
I. Tatouli ◽  
I. Dialoupi ◽  
F. Michas ◽  
...  
Keyword(s):  
Case Report ◽  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Bowel Obstruction ◽  
Surgical Repair ◽  
Myasthenic Crisis ◽  
Colon Adenoma ◽  
Bulbar Symptoms ◽  
Anastomosis Leakage ◽  
Receptor Antibodies

We report the case of a 63-year-old patient with myasthenia gravis (MG) due to acetylcholine receptor antibodies (AChR) who underwent colectomy due to colon adenoma and developed myasthenic crisis and anastomosis leakage after surgery. The patient underwent two plasma exchanges, 4 and 6 days preoperatively, and received intravenous prednisolone and immunoglobulin infusion due to the crisis, which included primarily bulbar symptoms. The patient developed on the 10th postoperative day bowel obstruction symptoms and anastomosis leakage which required surgical repair and ileostomy. Bowel obstruction occurred in a patient with AChR related myasthenia after plasma exchange and during immunosuppression although it is more commonly reported in patients with thymoma related myasthenia.

Single Donor Plasma in Therapeutic Plasma Exchange for Myasthenia Gravis

1987 ◽  
Vol 10 (5) ◽  
pp. 315-318 ◽  
Author(s):  
R. Mantegazza ◽  
E. Bruzzone ◽  
B. Regi ◽  
D. Peluchetti ◽  
M. Marconi ◽  
...  
Keyword(s):  
Side Effects ◽  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Optimal Schedule ◽  
Therapeutic Plasma Exchange ◽  
Single Donor ◽  
Short And Long Term ◽  
Donor Plasma

Thirty-seven myasthenic patients were treated with therapeutic plasma exchange (TPE) on different performance schedules using either random or single donor plasma. The two schedules had the same effects in terms of efficacy but single donor replacement gave significantly less side effects in the short and long term. A two exchange procedure on alternate days associated with immunosuppression seems to be an optimal schedule for the treatment of myasthenic patients. A single donor two-exchange on alternate days procedure appears to be safe, useful and can be repeated in patients who need frequent TPE.

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