A new guideline from the American Academy of Neurology recommends using plasma exchange to treat people with severe relapses in multiple sclerosis (MS) and related diseases, as well as those with certain kinds of nerve disorders known as neuropathies.
The guideline is published in the January 18, 2011, print issue of Neurologyฎ, the medical journal of the American Academy of Neurology.
Plasma exchange, formally known as plasmapheresis, is the process of taking blood out of the body, removing constituents in the blood's plasma thought to be harmful, and then transfusing the rest of the blood (mainly red blood cells) mixed with replacement plasma back into the body.
The guideline recommends doctors consider using plasma exchange as a secondary treatment for severe flares in relapsing forms of MS and related diseases. The treatment was not found to be effective for secondary progressive and chronic progressive forms of MS.
According to the guideline, doctors should offer plasma exchange for treatment of severe forms of Guillain-Barr้ syndrome and for temporary treatment of chronic inflammatory demyelinating polyneuropathy. Plasma exchange may also be considered for treatment of some other kinds of inflammatory neuropathies.
"These types of neurologic disorders occur when the body's immune system mistakenly causes damage to the nervous system. Plasma exchange helps because it removes factors in the plasma thought to play a role in these disorders," said guideline lead author Irene Cortese, MD, a neurologist with the National Institutes of Health in Bethesda, Md., and a member of the American Academy of Neurology.
The guideline authors also looked at the use of plasma exchange for other neurologic disorders, including myasthenia gravis and pediatric autoimmune neuropsychiatric disorders (PANDAS), but there was not enough evidence to determine whether it is an effective treatment.
Side effects of plasma exchange include infection and blood-clotting issues.
The guideline was endorsed by the American Association of Neuromuscular and Electrodiagnostic Medicine. The National Multiple Sclerosis Society endorsed the section of the guideline that relates to the use of plasma exchange for multiple sclerosis.
- I. Cortese, V. Chaudhry, Y.T. So, F. Cantor, D.R. Cornblath, A. Rae-Grant. Evidence-based guideline update: Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2011; 76: 294-300 DOI: 10.1212/WNL.0b013e318207b1f6
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