Investigators at Boston Children's Hospital and at University of Florida, Gainesville, studied the comparative efficacy of plasmapheresis (PLEX) vs immunoglobulin (IVIG) as maintenance therapy in juvenile myasthenia gravis (MG). A retrospective analysis over a 33-year period involved 54 children and adolescents with juvenile MG. Seven of 7 treated with PLEX alone responded, 5 of 10 treated with IVIG alone responded, and 9 of 10 patients who received both responded. Response rate to PLEX was significantly higher and more consistent than that of IVIG. Of 17 patients treated by thymectomy, 11 were significantly benefited. 
COMMENTARY. PLEX and IVIG both have high response rates as maintenance therapies for juvenile MG, but PLEX response is superior. Nine of 11 patients with response graded as “B”-good improvement [2, 3], had early thymectomies.