Plasmapheresis in neurologic disorders

Abstract

Two decades after the initial encouraging reports on plasmapheresis in myasthenia gravis, neurologic diseases represent the most common indication for therapeutic plasma exchange. Recent studies have not only established the therapeutic importance of plasmapheresis, but have also set new standards for the management of autoimmune neurologic disorders. Plasmapheresis has proved beneficial in autoimmune neurologic diseases such as Guillain-Barre syndrome, myasthenia gravis, and paraprotein-associated polyneuropathy. In some other diseases, e.g., multiple sclerosis, polymyositis, dermatomyositis, and chronic inflammatory demyelinating polyneuropathy, plasmapheresis cannot be considered a generally accepted therapeutic option. However, in chronic autoimmune diseases such as progressive multiple sclerosis, polymyositis, dermatomyositis, and chronic inflammatory demyelinating polyneuropathy, plasmapheresis is recommended in patients whose condition continues to worsen despite immunosuppressive drug therapies, and in those for whom it is desirable to reduce the dose of corticosteroids to avoid long-term complications. Based on the initial studies, plasmapheresis in conjunction with immunosuppressive drug therapies is now standard therapy for Eaton-Lambert syndrome.