title: Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study.
abstract: 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.
authors.affiliation: Erciyes Medical School, Department of Hematology and Apheresis Unit, 38039 Kayseri, Turkey.
authors.forename: Leylagul
authors.initials: L
authors.lastname: Kaynar
authors.forename: Fevzi
authors.initials: F
authors.lastname: Altuntas
authors.forename: Ismet
authors.initials: I
authors.lastname: Aydogdu
authors.forename: Burhan
authors.initials: B
authors.lastname: Turgut
authors.forename: Ismail
authors.initials: I
authors.lastname: Kocyigit
authors.forename: Sibel Kabukcu
authors.initials: SK
authors.lastname: Hacioglu
authors.forename: Sevda
authors.initials: S
authors.lastname: Ismailogullari
authors.forename: Nilda
authors.initials: N
authors.lastname: Turgut
authors.forename: M Ali
authors.initials: MA
authors.lastname: Erkurt
authors.forename: Ismail
authors.initials: I
authors.lastname: Sari
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oztekin
authors.forename: Musa
authors.initials: M
authors.lastname: Solmaz
authors.forename: Bulent
authors.initials: B
authors.lastname: Eser
authors.forename: Ali Ozdemir
authors.initials: AO
authors.lastname: Ersoy
authors.forename: Ali
authors.initials: A
authors.lastname: Unal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cetin
mesh_terms: 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