8
also considered one of the methods of elimination of IgM M [Latov N., 1995; Park YE et
al., 2010].
In cases of myasthenia gravis IgG antibodies appear to nicotine acetylcholine
receptors postsynaptic membrane, which leads to increasing muscle weakness
[Lindstrom JM et al. 1998]. In this case, the direct removal of antibodies by
plasmapheresis is very effective. It is made to promote the normalization of
immunoglobulin levels and reduction of the circulating immune complexes (CIC) of 1.7 -
2 times. In severe cases, patients can be quickly disconnected from the ventilator, but it
is a relatively short-term effect and requires fixing repeated sessions [Levis R.A. et al.,
1995; Kosachev V.D. et al., 2006]. However, along with plasmapheresis, the same
results are reached via intensive intravenous immunoglobulin therapy at a dose of 0.4 g
/ kg daily for three or five days [Gaidos P. et al., 1997]. Nevertheless, with intensive
plasmapheresis we can achieve better results in the treatment of myasthenic crises,
rather than intravenous administration of immunoglobulins [Myasthenia Gravis Clinical
Study Group ..., 1997; Fleury MC, Tranchant C., 2008; Gold R., Schneider-Gold C.,
2008; Tranchant C., 2009]. It is advisable to carry out 3-5 sessions of plasmapheresis
with removal of plasma up to 2.0-2.5 ml / kg body weight
[Köhler W.
et al., 2011].
Similarly, the use of plasma exchange provide faster positive effect (after the first
session already) in patients refractory to rituximab [Nowak RJ, 2011]. Plasmapheresis
before surgery thymectomy greatly facilitates the postoperative period [Yeh JH et al.,
2005; Gold R. et al., 2008; Konishi T., 2008; El-Bawab H. et al., 2009].
With juvenile forms of myasthenia gravis is also successfully used plasmapheresis
with immunoglobulins [Anlar B. et al., 2009; Chiang L.M. et al., 2009; Papazian O.,
Alfonso I., 2009].
Prospects are seen in the use of specific IgG-immunoadsorption to remove
antibodies to acetylcholine receptors [Zisimopoulou P. et al., 2008] as well as new
systems for the cascade plasmapheresis [Chuang YC et al., 2000; Batocchi A.P. et al.,
2000; Yeh J.H. et al., 2001, 2003, 2005; Konishi T., 2008]. Nevertheless, J.H. Yeh
H.C.Chiu (2000), and later by R. Pittayanon et al. (2009) compared the comparable
groups of patients with myasthenia noted no significant differences in the effectiveness
of immunoadsorption or cascade plasmapheresis. On the other hand J.F.Liu et al.
(2010)
observed
no
benefits
immunoglobulin
transfusions
before
cascade
plasmapheresis or immunoadsorption.
Myasthenic Lambert-Eaton syndrome is a rare disease that occurs as a result of
the blockade of the presynaptic release of acetylcholine in the nerve ending (at the
neuromuscular synapse). Interestingly, half of patients was with lung cancer. Diagnosis
is based on electromyography. Recent evidence suggests an autoimmune impact
directly against the momentum of the electrical installation in the calcium channels at
the presynaptic motor nerve terminal [Leys K. et al., 1991]. Used in the treatment of
immune suppression are improving agents conducting electrical discharge in the nerve
9
terminal. Plasmapheresis leads to improvements in the majority of patients, but requires
repeated sessions on immunosuppressive therapy [Dau PC, Denys EH, 1982; Sanders
DB, 1995; Ueda T. et al., 2009]
"Paraneoplastic" autoimmune diseases of the central nervous system. The term
"paraneoplastic" refers to the processes that accompany certain types of tumors,
especially ovarian and breast cancer. The presence of specific anti neural antibodies in
these patients supports the theory autoimmune origin of these disorders. There are
refered to antibody staining of Purkinje cells cytoplasm. On the other hand, the
detection of such antibodies in patients with neurological symptoms of cerebellar
degeneration was a highly specific marker for the presence in them of not yet diagnosed
tumors. J.W.B. Moll and collab. (1996) studied presence of antibodies, both anti neural
and "systems" (vs. DNA mitochondria thyroid antigens, rheumatoid factors), in patients
with paraneoplastic syndrome, and in patients with small cell lung cancer, ovarian
cancer and breast cancer, but no evidence of this syndrome, and a control group of
healthy individuals. It was found that the "systems" autoantibodies were found in 52% of
patients with paraneoplastic syndrome compared with 16% in the isolated tumors and
15% in the control group. Thus, the relatively high frequency of systems autoantibodies
in patients with paraneoplastic syndrome indicates some genetic predisposition to
autoimmune phenomenon. This explains the rare incidence of this syndrome in cancer
patients (i.e., the syndrome is implemented in cancer patients with a predisposition to
systemic autoimmune diseases).
The manifestations of this syndrome can be smoothed both after removal of the
tumor and in immunosuppressive therapy, including plasmapheresis [Dropcho E.J.,
1995
; Schröder A.
et al., 2009; Mirza M.K. et al., 2011; Pham H.P. et al., 2011]. Thus,
Y. Ben David et al. (1996) observed a significant improvement in neurological
manifestations in patients with ovarian cancer and cerebellar degeneration after a
course of plasmapheresis, although F. Graus et al. (1992), this result is not obtained.
A.M. Landtblom et al. (2008), conducting courses in 3 sessions (a total of 22 per year),
was also prepared with only a temporary effect.
Could develop such a rare variety of paraneoplastic syndrome may develop as
melanocytic proliferation of choroid, also treated with plasmapheresis [Jaben EA et al.,
2011].
Amyotrophic lateral sclerosis - relentlessly progressive neurological syndrome in
which there is destruction of motor neurons, leading to increasing weakness of the facial
muscles and limbs, atrophy with spastic symptoms, hyperactivity reflexes, respiratory
failure and imminent death within three years. The detection rate - 3.1 per 100 000
population. Some patients have antibodies influencing the conduction of impulses
through the calcium channels of neuromuscular synapses, which leads to motor neuron
disorders and swelling of the fragmentation of the Golgi apparatus [Offen D. et al.,
1998]. In addition, the detected small infiltrates of T-cells in the brain and spinal cord to