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Guidelines Recommend Plasma Exchange for MS

American Academy of Neurology Says Treatment Works for Some Types of Multiple Sclerosis
WebMD Health News
Reviewed by Laura J. Martin, MD

Jan. 19, 2011 -- Updated guidelines from the American Academy of Neurology recommend plasma exchange (plasmapheresis) for the treatment of certain types of multiple sclerosis (MS) and other inflammatory neurological conditions, including Guillain-Barré syndrome and CIDP (chronic inflammatory demyelinating polyneuropathy).

Plasma exchange involves replacing the plasma (the liquid part of a person’s blood) with plasma from a donor. Plasma exchange removes factors in the blood’s plasma thought to play a role in these disorders.

The time-consuming therapy involves separating the plasma from other blood components such as blood cells, replacing the plasma, and returning the other components. Risks may include infection, allergic reaction, and blood-clotting issues.

The new guidelines, which appear in the Jan. 18 issue of Neurology, were last updated in 1996. While many of the core recommendations remain the same, the new guidelines state that there is insufficient evidence to support or refute the use of plasma exchange in the treatment of myasthenia gravis, a chronic condition that causes muscles to weaken easily, and pediatric autoimmune neuropsychiatric disorders that result from streptococcal infection.

“This is really an established therapy and we know more about which diseases it is useful in, and which diseases it isn’t useful or needs to be looked at again,” says guidelines author Alex Rae-Grant, MD, a neurologist at The Neurological Institute at Cleveland Clinic in Ohio.

For example, “we are not saying you can’t use it in myasthenia gravis, but it’s ripe for reassessment and we need to think about whether we could do a trial in more rigorous fashion,” he says. Plasma exchange is currently used in many medical centers to treat myasthenia gravis and myasthenic crisis, which occurs when myasthenia gravis affects the breathing muscles and the disease hits a crisis point.

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