ABSTRACT
Therapeutic plasma exchange (TPE), also known as plasmapheresis or apheresis, has been studied as a treatment for MS since 1980. Studies con ducted over the past 18 years have not conclu sively established whether TPE is effective for progressive multiple sclerosis (MS) or for acute attacks of MS. Noseworthyt1! has previously reviewed the benefits of TPE in progressive MS. Since that time, Vamvakas and colleagues^ have published a review and meta-analysis of six prospective controlled studies published as of 1992 (the date of Noseworthy’s previous review), but new studies have not been undertaken. Studies in progressive MS have been contradic tory, although the meta-analysis suggests that TPE may have a weak beneficial effect in prevent ing deterioration at 12 months from initiation of treatment when combined with other immuno suppressive treatment.^
Perhaps more promising than the studies in patients with progressive MS are a series of uncontrolled observations suggesting that TPE can result in dramatic improvement in neurologi cal function in patients with acute, severe attacks of demyelinating disease. In most instances, patients who appeared to benefit had severe neu rological disability, apparently unresponsive to
corticosteroid therapy. A controlled study by Weiner and colleagues^3! failed to support the efficacy of TPE in acute attacks of MS when used as an adjunct to an intensive immunosuppressive treatment. However, a hint of benefit was observed in those who had relapsing-remitting MS (RRMS) with the most severe attacks. In order to address the putative benefit of TPE alone in patients with acute, severe attacks of demyeli nating disease, investigators at the Mayo Clinic have conducted a 4-year, randomized, double blind study of TPE in acute, severe attacks of inflammatory demyelinating disease.
