Plasma exchange in neurological disease

Osman, Chinar; Jennings, Rachel; El‐Ghariani, Khaled; Pinto, Ashwin

doi:10.1136/practneurol-2019-002336

Cited by 37 publications

(41 citation statements)

References 77 publications

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“…These results support recently renewed interest in TPE as an effective treatment to rapidly reduce the concentration of circulating autoantibodies in patients with devastating rapidly progressive AE secondary to antibodies against LGI1, contactin-associated protein-2 (CASPR2), and NMDAR. 13 Severe AE poses significant clinical challenges to neurologists due to its rapid progression and the risk of permanent neurological disability if not treated early and aggressively. Although there is little evidence from randomized clinical trials, experience from published case series suggests that TPE is important to improve the patient's clinical condition.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Zhang

Huang

Chen

et al. 2021

Ann Clin Transl Neurol

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Objective To determine the clinical and antibody response after therapeutic plasma exchange (TPE) in patients with severe refractory antibody‐associated autoimmune encephalitis (AE). Methods This single‐center prospective cohort included all patients consecutively admitted to our hospital because of severe refractory AE over the period from July 2014 to June 2019. All patients received immunotherapy (steroids, intravenous immunoglobulin (IVIG), and/or TPE). The primary outcome was evaluated at 1‐ and 2‐month postenrollment, and the long‐term outcome was followed up at 6 and 12 months. AE antibody titers in the cerebrospinal fluid and plasma were evaluated before and after TPE/IVIG. Results This study enrolled 57 patients with severe refractory AE, including anti‐NMDA receptor encephalitis (n = 51), anti‐GABAb receptor encephalitis (n = 3), anti‐LGI 1 encephalitis (n = 2), and anti‐AMPA receptor encephalitis (n = 1). Of all 57 patients, 33 patients received TPE for a total of 193 procedures, and 24 patients with contraindications or refusal of TPE were in the non‐TPE group. Compared with the non‐TPE group, the TPE group exhibited greater clinical improvement: 21 (37%) versus 8 (14%) after 1 month (P = 0.03) and 31 (54%) versus 16 (28%) after 2 months (P = 0.01), respectively. Complications and adverse events associated with TPE occurred in 91 procedures (47%) without serious adverse events associated with the use of TPE. Interpretation TPE might be an effective rescue therapy associated with rapid functional improvement in patients with severe steroid/IVIG refractory antibody‐associated AE from this nonrandomized control trial.

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Section: Discussionmentioning

confidence: 99%

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Zhang

Huang

Chen

et al. 2021

Ann Clin Transl Neurol

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“…PLEX is a highly efficient technique that removes antibodies and humoral factors from the circulation. 37 Conventionally, PLEX has been performed using a central line; however, peripheral access is increasingly used as techniques develop with improved safety profile. 37,38 An alternative to PLEX is immunoadsorption (IA).…”

Section: Plex and Immunoadsorptionmentioning

confidence: 99%

“…37 Conventionally, PLEX has been performed using a central line; however, peripheral access is increasingly used as techniques develop with improved safety profile. 37,38 An alternative to PLEX is immunoadsorption (IA). The mechanisms underlying the therapeutic effects of IA treatment are not fully understood but are thought to involve the removal of pathogenic humoral factors from circulating blood through a high-affinity adsorbent with tryptophan or phenylalanine.…”

Section: Plex and Immunoadsorptionmentioning

confidence: 99%

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Treatment of myelin oligodendrocyte glycoprotein immunoglobulin G–associated disease

Healy

Elhadd

Gibbons

et al. 2021

Clinical & Exp Neuroim

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Myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG)–associated disease (MOGAD) is increasingly recognized as a distinct nosological entity from aquaporin‐4 antibody IgG–positive neuromyelitis optica spectrum disorder (AQP4‐IgG NMOSD). The advent of highly specific MOG‐IgG cell‐based diagnostic assays have helped to refine our understanding of the clinical spectrum of MOGAD. To date, treatment approaches have been largely extrapolated from AQP4‐IgG NMOSD experience, but there is growing evidence of distinct differences in treatment response between these conditions. This review summarizes the current status and understanding of acute and chronic treatments for MOGAD. Timing and duration of treatment, pregnancy, and emerging therapies are also discussed.

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“…Citrate can cause symptomatic hypocalcemia, and patients may develop allergic reactions due to the infusion fluid 68 . Hypotension, arrhythmias and tetany may occur; therefore, patient monitoring is required during the procedure 69 .…”

Section: Therapeutic Plasma Exchangementioning

confidence: 99%

Immunosuppressors and immunomodulators in Neurology - Part I: a guide for management of patients underimmunotherapy

Abrantes

Moraes

Filho

et al. 2021

Arq. Neuro-Psiquiatr.

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For patients with autoimmune diseases, the risks and benefits of immunosuppressive or immunomodulatory treatment are a matter of continual concern. Knowledge of the follow-up routine for each drug is crucial, in order to attain better outcomes and avoid new disease activity or occurrence of adverse effects. To achieve control of autoimmune diseases, immunosuppressive and immunomodulatory drugs act on different pathways of the immune response. Knowledge of the mechanisms of action of these drugs and their recommended doses, adverse reactions and risks of infection and malignancy is essential for safe treatment. Each drug has a specific safety profile, and management should be adapted for different circumstances during the treatment. Primary prophylaxis for opportunistic infections and vaccination are indispensable steps during the treatment plan, given that these prevent potential severe infectious complications. General neurologists frequently prescribe immunosuppressive and immunomodulatory drugs, and awareness of the characteristics of each drug is crucial for treatment success. Implementation of a routine before, during and after use of these drugs avoids treatment-related complications and enables superior disease control.

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Plasma exchange in neurological disease

Cited by 37 publications

References 77 publications

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Clinical efficacy of plasma exchange in patients with autoimmune encephalitis

Treatment of myelin oligodendrocyte glycoprotein immunoglobulin G–associated disease

Immunosuppressors and immunomodulators in Neurology - Part I: a guide for management of patients underimmunotherapy

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