ABSTRACT
Therapeutic plasma exchange (TPE), also known as plasmapheresis or apheresis, has been studied as a treatment for multiple sclerosis (MS) since 1980. The effects of TPE on MS are perhaps best considered by examining two distinct patient groups, those with progressive forms of MS and those with acute, severe attacks of MS and other idiopathic inflammatory demyelinating diseases. Evidence for efficacy is equivocal and modest at best in progressive MS. However, a sizeable proportion of patients with acute, severe attacks experience marked and rapid improvement. Noseworthy reviewed the use of TPE in progressive MS.[1] Since that time, Vamvakas et al. published a review and metaanalysis of six prospective controlled studies.[2] Recently, a controlled clinical trial at the Mayo Clinic demonstrated that TPE is an effective treatment for acute, severe attacks of inflammatory demyelination of MS and other idiopathic inflammatory demyelinating disease in patients who do not respond to conventional treatment with high-dose corticosteroid therapy.[3]
This chapter considers the results of clinical series and controlled trials, adverse effects, and possible mechanisms of action of TPE in neurological and non-neurological diseases. It reviews the meta-analysis by Vamvakas et al. about the efficacy of TPE for progressive MS; however, it focuses on the results of the randomized trial performed at the Mayo Clinic. It reviews data from a retrospective study that included all patients with acute, severe attacks of demyelinating disease at the Mayo Clinic treated with TPE from 1984 to 2000[4] that identified clinical factors that predict favorable response to TPE. It then considers the possible mechanisms of action of TPE in these inflammatory demyelinating diseases of the central nervous system (CNS).
