Modern approaches to the treatment of myasthenia gravis: possibilities of plasmapheresis and a clinical case of refractory course

Myasthenia is a chronic autoimmune disorder of the neuromuscular junction characterized by pathological muscle fatigability and skeletal muscle weakness. Myasthenic crises are of particular clinical significance, as they are associated with the development of bulbar and respiratory dysfunction and require urgent treatment. This paper provides a contemporary overview of treatment approaches for myasthenia gravis, including acetylcholinesterase inhibitors, immunosuppressive therapy, biological agents, thymectomy, and rapid immunomodulatory therapies. Particular attention is focused on the role of plasmapheresis as one of the main treatment modalities for severe exacerbations and myasthenic crisis. A clinical case of a patient with seropositive generalized myasthenia gravis (AChR-positive), MGFA class IVB, refractory to standard medical therapy, is presented. Despite a course of therapeutic plasmapheresis, no significant clinical improvement was achieved. Further evaluation revealed metastatic involvement of the lungs and mediastinum, which may have affected the course of the disease and treatment efficacy. Positive clinical dynamics were observed following a course of intravenous immunoglobulin therapy. This clinical case demonstrates that the effectiveness of plasmapheresis depends not only on its use itself but also on the timing of treatment initiation, disease severity, comorbid conditions, characteristics of the apheresis technology, plasma exchange volume, and technical specifications of the equipment used. The findings highlight the importance of a personalized approach to the management of myasthenia gravis and the flexible use of available rapid immunomodulatory therapies according to the individual clinical response of the patient.