MONDAY, Jan. 17 (HealthDay News) -- A blood-filtering procedure
called plasma exchange helps ease severe flares of multiple
sclerosis (MS), but does not help with more advanced, progressive
forms of the disease, new guidelines say.
Plasma exchange, or plasmapheresis, is also effective in
treating severe forms of Guillain-Barre syndrome and chronic
inflammatory demyelinating polyneuropathy and it may be considered
to treat some other kinds of inflammatory neuropathies, according
to the American Academy of Neurology guidelines.
Periodically, the academy reviews the available research on
various procedures, ranks the evidence according to quality of the
research and issues new recommendations that many neurologists use
in their practice.
The updated guidelines, based on a review of research published
between 1995 and 2009, are published in the Jan. 18 issue of
Neurology. The previous guidelines were issued in 1996.
"With multiple sclerosis, plasmapheresis works, but only with the acute attacks, and it should also be used only when steroids do not work," said guidelines co-author Dr. Vinay Chaudhry, a professor of neurology at Johns Hopkins University School of Medicine. "If the MS is chronic or progressive, not the relapsing or remitting type, plasmapheresis does not work."
In plasma exchange, developed in the 1970s, a patient's blood is
removed from the body and filtered. The patient's blood and
platelets are returned, but the plasma is replaced with donor
Though physicians aren't entirely sure why plasma exchange
works, it's generally believed that filtering removes harmful
proteins and antibodies in the plasma that attack the central
Multiple sclerosis is an autoimmune disease in which the body's
own immune system attacks myelin, or the sheath that insulates
nerve fibers of the central nervous system. The damage disrupts
nerve signals traveling to and from the brain, which can lead to
numbness, movement difficulties, blurred vision, fatigue and
About 85 percent of those with MS start with a
relapsing-remitting course, in which attacks are followed by
partial or total recovery. Eventually, more than half go on to
develop a more progressive form of the disease with fewer and
shorter symptomless periods.
At the outset of the disease, doctors usually treat MS flares
with steroids, said Dr. Lily Jung, medical director of the
neurology clinic at the Swedish Neuroscience Institute in
According to the guidelines, if the attack is particularly
severe and the steroids are not helping, doctors should consider
using plasma exchange.
However, the treatment is not effective for more advanced and
aggressive forms of the disease, including chronic or secondary
progressive forms, the guidelines say.
Researchers also looked at the evidence for the use of plasma
exchange for other neurologic disorders, including myasthenia
gravis and pediatric autoimmune neuropsychiatric disorders
associated with streptococcus infection, but there was not enough
evidence to determine whether it is an effective treatment.
The recommendations make sense, Jung said. Plasmapheresis can be
grueling and generally requires a hospital stay of about 10 days.
Complications can include infection and blood clots, so it should
be reserved for patients with a severe flare, which may include an
inability to walk and the possibility of months of physical
"In patients with relapsing disease who are not doing well with steroids, and their deficits are great enough to warrant it, this may not be a bad thing and might allow them to get out of the hospital sooner," Jung said.
U.S. National Institute of Neurological Disorders and
Stroke has more on multiple sclerosis.
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