Which treatment is used in myasthenic crisis to remove circulating antibodies?

• A. Antibiotics
• B. Steroids only
• C. Plasmapheresis
• D. IVIG only

Answer: (C)

During a myasthenic crisis, the goal is to rapidly reduce the circulating autoantibodies against the acetylcholine receptor that impair neuromuscular transmission. Plasmapheresis achieves this by exchanging the patient’s plasma, effectively removing the pathogenic antibodies from the bloodstream and replacing it with donor plasma or an albumin solution. This direct removal leads to a quicker improvement in diaphragm and other skeletal muscle strength, which is crucial in crisis when respiratory function is at risk.

Steroids can help by decreasing antibody production, but their onset is slower and they don’t provide the rapid reduction needed in an acute crisis. IVIG can modulate the immune system and help in MG, but it does not physically remove circulating antibodies as plasmapheresis does. Antibiotics have no role in addressing the autoimmune process of myasthenia gravis.

So, the treatment that specifically removes circulating antibodies in a myasthenic crisis is plasmapheresis.