Plasma exchange and IV immunoglobulin for acute demyelinating relapses

Chapter

Abstract

  • The studies exploring the use of plasma exchange (PE) for severe MS-associated relapses that recover poorly following treatment with high-dose steroid therapy (or in rare instances where high-dose glucocorticosteroids are contraindicated) has demonstrated conflicting results. Plasma exchange involves non-selectively removing plasma components that are potentially pathogenic in immune-mediated diseases from a patient's blood [1]. Some of these components are antibodies, immune complexes, and complement, while others are currently unknown. Vascular access is usually obtained by inserting a central venous catheter into the subclavian or internal jugular veins. Alternatively, vascular access may be obtained by inserting two needles in two peripheral veins. Plasma exchange is usually performed using a membrane filtration technique and the plasma is exchanged with 5% albumin solution. A total volume of 2000–3000 ml is typically exchanged during each treatment and the patients typically undergo 5–7 treatments, usually on every other day. The results of several small, uncontrolled trials have been difficult to interpret because of the use of concomitant immunosuppressive therapy and poor trial design. A double-blind crossover trial showed that two-week alternate-day PE treatment resulted in appreciable clinical improvement in about 42% of the patients with acute inflammatory demyelination who had been unresponsive to intravenous glucocorticoid therapy (a minimum of 500 mg of intravenous methylprednisolone for 5 days) [2].
  • Authors

    Digital Object Identifier (doi)

    International Standard Book Number (isbn) 13

  • 9780521763493
  • Start Page

  • 87
  • End Page

  • 91