Therapeutic plasma exchange in neurology: 2012

Abstract

In treating neuro-immunological diseases, neurologists have a number of different drugs to choose from ranging from corticosteroids to IVIg to more specific cell based therapies, the latter most frequently from the world of Oncology. In some diseases, therapeutic plasma exchange, a procedure rather than a drug, is used. The most obvious advantage of therapeutic plasma exchange is the usually rapid onset of action presumably due to removal of pathogenic auto-antibodies. In some diseases, a single course of therapeutic plasma exchange is used while in others prolonged treatment with therapeutic plasma exchange is used. This article will review the use of therapeutic plasma exchange in neurology and will draw heavily upon recent consensus statements from the American Society for Apheresis and the American Academy of Neurologyand by Cochrane reviews.

Efficacy and Safety of Plasma Exchange with 5% Albumin to Modify Cerebrospinal Fluid and Plasma Amyloid-β Concentrations and Cognition Outcomes in Alzheimer’s Disease Patients: A Multicenter, Randomized, Controlled Clinical Trial

“…This is what could be expected in patients treated with PE [43–45]. PE is safely used in some neurologic diseases [46] as well as in chronic conditions such as familial hypercholesterolemia [47]. In this study, PE showed in general a comparable safety and tolerability profile.…”

Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

“…Since then the range of indications for treatment has expanded significantly, with neurological conditions constituting a large proportion. 3 However, the uptake of TPE in children remains limited; in a recent survey of 42 North American paediatric hospitals providing TPE, the treatment was used in only 13.4% of children admitted for category I (first-line) American Society for Apheresis (ASFA) indications, and only 9.3% of those admitted for category II (second-line) indications. 4 In this article we provide an overview of the theoretical basis for TPE in neurological diseases of the central and peripheral nervous systems, review the indications and evidence for TPE in those diseases affecting children, and discuss the practical, technical, safety, and tolerability issues to be considered when embarking upon TPE in children, and its use alongside other immune therapies.…”

“…3). 3,7,87,88 When planning a sequence of therapies, the question arises of the appropriate interval between treatments. In the acute context our practice is to allow 48 to 72 hours for treatment effect to become apparent before initiating the next therapy; but this interval may be reduced in fulminant or life-threatening presentations (Fig.…”

Immunoadsorption or plasma exchange in steroid‐refractory multiple sclerosis and neuromyelitis optica

“…7 Thus, the use of PE in steroid-refractory MS relapses has become an integral part of European guidelines 8 and is also recommended by the American Academy of Neurology as a second-line treatment (Level B). 9,10 Neuromyelitis optica (NMO) is another chronic inflammatory and demyelinating autoimmune CNS disease. In NMO as well, PE is the established second line therapy in case of steroid resistance.…”