Beneficial Effects of Plasma Exchange in Acute Inflammatory Polyradiculoneuropathy

Osterman, P. O.; Lundemo, G.; Pirskanen, Ritva; Fagius, Jan; Pihlstedt, P; Sidén, Å; Säfwenberg, Jan

doi:10.1016/s0140-6736(84)90819-5

Cited by 230 publications

(97 citation statements)

References 16 publications

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“…There is not much data available of the plasmapheresis effect on different disease. [10][11][12] Our results for PE were comparable to other studies for GBS, 2 cycles of PE are more beneficial than 1 cycle. PE is more beneficial when started within seven days after disease onset rather than later, but was still beneficial in patients treated up to 30 days after disease onset.…”

Section: Resultssupporting

confidence: 86%

Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

Mittal¹,

Agrawal²,

Singh³

2016

Int J Adv Med

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Section: Resultssupporting

confidence: 86%

Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

Mittal¹,

Agrawal²,

Singh³

2016

Int J Adv Med

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“…In 1984, two small clinical trials showed some positive effects of plasma exchange in GBS 79,80 , and in 1985, a larger study confirmed the effect and demonstrated that plasma exchange in patients who were unable to walk hastened recovery, especially when started within 2 weeks of GBS onset 81 .A subsequent study obtained similar results 82 . Plasma exchange consequently became the first proven therapy for GBS, but the treatment is not always straightforward and carries particular risks for patients with autonomic disturbance, which is common in GBS.…”

Section: [H1] Therapymentioning

confidence: 95%

Guillain–Barré syndrome: a century of progress

2016

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In 1916, Guillain, Barré and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts -novel findings that identified the disease we now know as Guillain-Barré syndrome (GBS).100 years on, we have made great progress with the clinical and pathological characterization of GBS. Early clinicopathological and animal studies indicated that GBS was an immune-mediated demyelinating disorder with secondary axonal injury if severe; the current treatments of plasma exchange and intravenous immunoglobulin, which were developed in the 1980s, are based on this premise. Subsequent work has, however, shown that the underlying disease can be an axonal injury. The association of Campylobacter jejuni strains has led to confirmation that anti-ganglioside antibodies are pathogenic and that axonal GBS involves an antibody and complement-mediated disruption of nodes of Ranvier, neuromuscular junctions and other neuronal and glial membranes. Now, ongoing clinical trials of the complement inhibitor eculizumab are the first of targeted immunotherapy in GBS.Guillain-Barré syndrome (GBS) is the commonest cause of acute flaccid paralysis and manifests as rapidly evolving weakness and sensory disturbance in arms, legs and in some patients, facial, bulbar and respiratory muscles. Many patients will make a good recovery over many months but in severe cases patients can require months of intensive care support and be left with permanent severe weakness, sensory disturbance and pain. Furthermore, around 5% die from complications including respiratory failure, pneumonia and arrhythmias, making it a medical emergency with a high morbidity and significant mortality.Descriptions of clinical cases that closely resemble the condition we now know as GBS were made at least as early as 1859, when Jean Baptiste Octave Landry reported on "acute ascending paralysis". His report led to use of the term "Landry's ascending paralysis" to describe subacute ascending peripheral sensory and motor dysfunction. He observed that:

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“…In the present study the clinical outcome was slightly higher than the above study 82.35%. 10 Hahn AF et al reported 80% improvement in GBS. 12 out of 15 patients completely respond to plasma exchange with substantial improvement in neurological function.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic plasma exchange in neuro-immunological disorder

2017

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Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. Examples of these substances include immune complexes, pathogenic autoantibodies, endotoxin, cryoglobulins and cholesterol-containing lipoproteins and myeloma light chains. Therapeutic Plasma exchange is a well-established therapeutic procedure most commonly used in many neuro-immunological disorders. The benefit of plasma exchange occurs by elimination of pathognomonic inflammatory mediators, including complement components, autoantibodies and cytokines. Various studied have demonstrated that TPE plays an important role in neuro-immunological disorder (eg. Guillain-Barré syndrome, myasthenia gravis and other forms of immune neuropathies). Methods: It is descriptive and prospective study on the effect of TPE in neuro-immunological disorders. TPE are studied prospectively for a period from September 2011 to August 2013. The amount of plasma to be exchanged during TPE was determined using the formula EPV = (0.065 x weight [kg]) x (1-hematocrit). TPE was performed using a Haemonetics MCS+ intermittent flow cell separator. An average of 1-1.5 plasma volume is removed on alternative days. Clinical outcome of TPE was assessed at the time of discharge. Results: A total of 138 Therapeutic plasma exchange procedure were performed on 30 patients. In which the improvement begins within days of commencing the treatments and progressed steadily so that 25 out of 30 patients who responded favourably to TPE with a manageable adverse reaction. And only 5 patients failed to respond this therapy. So the clinical outcome for therapeutic plasma exchange for Neuro-immunological cases were 83.3% and remaining 16.7% doesn't show any improvement after five plasma exchanges. Conclusions: Therapeutic plasma exchange is a first line of management for most of the neuro-immunological disorder. In our study there was an improvement in motor performance after 3-5 plasma exchanges which are mainly due to removal of unbound antibodies from the plasma. Although the statistical power of our study was not sufficient to allow definitive conclusion, the result strongly suggest that 3-5 procedures on alternative days with 1-1.5 volume of plasma exchange gives a better result in patient with neuro-immunlogical diseases. The success of therapeutic plasma exchange also depends on composition of the replacement fluid. The risk and complication associated with procedure are also minimal and easily manageable.

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Beneficial Effects of Plasma Exchange in Acute Inflammatory Polyradiculoneuropathy

Cited by 230 publications

References 16 publications

Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

Guillain–Barré syndrome: a century of progress

Therapeutic plasma exchange in neuro-immunological disorder

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