Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study.
Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune etiology was known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university hospitals. The study was a retrospective review of the medical records of neurological patients (n=57) consecutively treated with TPE between April 2006 and May 2007. TPE indications in neurological diseases included Guillain-Barrè Syndrome (GBS) (n=41), myasthenia gravis (MG) (n=11), acute disseminated encephalomyelitis (ADEM) (n=3), chronic inflammatory demyelinating polyneuropathy (CIDP) (n=1) and multiple sclerosis (MS) (n=1). Patient median age was 49; there was a predominance of males. Twenty-two patients had a history of other therapy including intravenous immunoglobulin (IVIG), steroid, azothioprin, and pridostigmine prior to TPE. Another 35 patients had not received any treatment prior to TPE. All patients were classified according to the Hughes functional grading scores pre- and first day post-TPE for early clinical evaluation of patients. The TPE was carried out 1-1.5 times at the predicted plasma volume every other day. Two hundred and ninety-four procedures were performed on 57 patients. The median number of TPE sessions per patient was five, and the median processed plasma volume was 3075mL for each cycle. Although the pre-TPE median Hughes score of all patients was 4, it had decreased to grade 1 after TPE. While the pre-TPE median Hughes score for GBS and MG patients was 4, post-TPE scores were decreased to grade 1. Additionally, there was a statistically significant difference between post-TPE Hughes score for GBS patients with TPE as front line therapy and patients receiving IVIG as front line therapy (1 vs. 3.5; p=0.034). Although there was no post-TPE improvement in Hughes scores in patients with ADEM and CIDP, patients with MS had an improved Hughes score from 4 to 1. Mild and manageable complications such as hypotension and hypocalcemia were also observed. TPE may be preferable for controlling symptoms of neuroimmunological disorders in early stage of the disease, especially with GBS.
Kaynar
Leylagul
L
Erciyes Medical School, Department of Hematology and Apheresis Unit, 38039 Kayseri, Turkey.
Altuntas
Fevzi
F
Aydogdu
Ismet
I
Turgut
Burhan
B
Kocyigit
Ismail
I
Hacioglu
Sibel Kabukcu
SK
Ismailogullari
Sevda
S
Turgut
Nilda
N
Erkurt
M Ali
MA
Sari
Ismail
I
Oztekin
Mehmet
M
Solmaz
Musa
M
Eser
Bulent
B
Ersoy
Ali Ozdemir
AO
Unal
Ali
A
Cetin
Mustafa
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D004673:Encephalomyelitis, Acute Disseminated / Q000097:blood / Q000628:therapy*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000097:blood / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000628:therapy*; D009157:Myasthenia Gravis / Q000097:blood / Q000628:therapy*; D010951:Plasma Exchange / Q000379:methods*; D010956:Plasmapheresis / Q000379:methods; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000097:blood / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome