Plasma Exchange in Neurological Diseases

Abstract

The rationale for and results of plasma exchange (PE) in the therapy of different immune-mediated neurological diseases such as myasthenia gravis, multiple sclerosis, acute and chronic-relapsing Guillain-Barré syndromes, polymyositis, dermatomyositis and amyothrophic lateral sclerosis are reviewed. Dialysis dementia and Refsum’s disease, subacute sclerosing panencephalitis and schizophrenia are mentioned, too. If we exclude the treatment of acute Guillain-Barré syndrome, where PE alone appears to be sufficient to produce recovery or improvement, the combined use of immunosuppressive drugs and/or lymphocytapheresis is probably needed in the treatment of the other diseases. PE allows the disease to be controlled rapidly while long-term pharmacological control is established. An underlying theme in this review is the need of adequately controlled studies or at least of large case lists with exhaustive reports concerning both positive and negative results since a new perspective is needed for this topic. Nonetheless, a number of uncontrolled observations suggest that probably PE effectiveness in most immune-mediated neurological diseases could be proven if the requisite trials were performed.

Plasma Exchange as a Therapy for Guillain-Barré Syndrome with Immune Complexes

“…In this report we will summarize our positive experience with PE in 7 patients with GBS who have been treated with a fixed protocol in which steroids or immunosuppressive drugs were not included. 4 patients have been reported elsewhere [8]. Double-blind studies and sham exchanges were not carried out for ethical reasons.…”

Immunological Monitoring of a Patient with Guillain-Barré Syndrome Successfully Treated with Plasma Exchange

“…It has been recently pointed out that plasma exchange determines an improve ment only in those patients with immuno logical diseases in whom immune com plexes are detectable, being without benefit in those with no circulating immune com plexes [4], According to this classification, assignment of our patient to one of the two groups is difficult. However, successful treatment ofimmunologically mediated dis eases with plasma exchange cannot simply be explained by a reduction in immune com plexes.…”

“…Many factors seem to play a role [4], including the unblocking of the reticuloen dothelial system [9] and possibly some not yet identified lymphokines [10].…”

“…Not many other cases have been described thereafter [2][3][4]; moreover, its mode of action is still incom pletely understood. However, the rationale for treating with plasma exchange patients with Guillain-Barré syndrome is provided by the detection, in this disease, of toxic humoral factors, such as antimyelin anti bodies [1] and immune complexes [3].…”

Plasma Exchange as a Therapy for Guillain‐Barré Syndrome with Immune Complexes

“…In this report we will summarize our positive experience with PE in 7 patients with GBS who have been treated with a fixed protocol in which steroids or immunosuppressive drugs were not included. 4 patients have been reported elsewhere [8]. Double-blind studies and sham exchanges were not camed out for ethical reasons.…”