Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

Abstract

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain‐Barré syndrome

“…Previous studies primarily described outcomes of one of these two treatments using case series of patients diagnosed with GBS and/or similar conditions from a single institution. These studies often originated from developing countries . For instance, a retrospective study involving 230 South Indian TPE‐treated patients diagnosed with neurological disorders reported that GBS was a key diagnosis .…”

“…According to evidence‐based guidelines by the American Academy of Neurology, the two recommended treatment options for severely affected Guillain‐Barré syndrome (GBS) patients are therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) . Both treatments were shown to be effective and superior to conservative treatment for disability recovery .…”

“…Recently published comparative and noncomparative studies of GBS outcomes after treatment with TPE and/or IVIG have consisted primarily of case reports or case series from single institutions in developing countries, at which the choice between TPE and IVIG is largely dependent on economic considerations . Given the established equivalence between TPE and IVIG as effective treatments for GBS, it is important to evaluate patient‐ and hospital‐level characteristics that may affect treatment selection.…”

Therapeutic Plasmapheresis with Albumin Replacement in Alzheimer’s Disease and Chronic Progressive Multiple Sclerosis: A Review

“…The knowledge that the main toxic factors for AD pathology are the accumulation of Aβ in the brain, and circulating Aβ peptides crossing into the brain, and contributing to neurological impairment, led to tests of how PP can reduce the Aβ burden in AD patients in a pioneering study by Boada et al [26]. Considering that 90% of circulating Aβ is linked to albumin, a mobilization of plasma Aβ after PP could induce a mobilization of brain Aβ, and a therapeutic effect in AD patients could consequently be observed [33]. This may indicate that the removal of Aβ proteins, and perhaps other unknown proteins by PP, initiates a more long-lasting process, or processes in the CNS, with beneficial effects on cognition.…”

Mortality and disability reported after immunoglobulins or plasmapheresis treatment of Guillain-Barré syndrome

“…Also, it is advisable to treat those cases that do not improve after 4 weeks of illness [10][11][12][13][14]. However, due to the significant heterogeneity of studies and the quality of available evidence, the universal validity of these conclusions remains questionable [15][16][17][18][19][20][21][22][23][24]. Furthermore, there are only a few clinical trials that have evaluated the effectiveness of plasmapheresis or immunoglobulin in the treatment of GBS types.…”