title: The clinical value of therapeutic plasma exchange in multifocal motor neuropathy.
abstract: OBJECTIVE
  Although there is evidence for a pathogenic role of humoral factors in multifocal motor neuropathy (MMN), plasma exchange (PE) is assumed to be an ineffective treatment. We set out to elucidate possible reasons for this apparent contradiction.
  
  
  METHODS
  A retrospective analysis of seven patients with MMN, who underwent 4 to 18 sessions of PE. Clinical response, electrophysiological parameter and anti-ganglioside antibody titers were reviewed.
  
  
  RESULTS
  Two patients, who had anti-ganglioside antibodies, exhibited transient clinical responses to PE, manifested by improved neurological function. Whereas electrophysiological parameters continued to worsen in all patients, anti-ganglioside antibody titers declined during PE, but increased after PE.
  
  
  CONCLUSIONS
  PE is of limited therapeutic value in patients with MMN, who do not respond to established treatment options. It may only be useful as an adjunctive treatment in a subset of patients. The transient decrease of anti-ganglioside-antibodies titers suggests that pathogenic humoral factors in MMN are only temporarily reduced. Further, PE treatment alone is insufficient to prevent axons from continuing degeneration, which may explain the failure of PE to substantially influence the disease course of patients with MMN.
authors.affiliation: Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany. helmar.lehmann@uni-duesseldorf.de
authors.forename: Helmar C
authors.initials: HC
authors.lastname: Lehmann
authors.forename: Felix R
authors.initials: FR
authors.lastname: Hoffmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Fusshoeller
authors.forename: Gerd
authors.initials: G
authors.lastname: Meyer zu Hörste
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hetzel
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.forename: Michael
authors.initials: M
authors.lastname: Schroeter
authors.forename: Bernd C
authors.initials: BC
authors.lastname: Kieseier
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005732:Gangliosides / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000097:blood / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D009431:Neural Conduction / Q000502:physiology; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D005732:Gangliosides