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Saturday, May 31, 2014

PLASMA EXCHANGE FOR TREATING NEUROLOGIC DISORDERS: AMERICAN ACADEMY OF NEUROLOGY GUIDELINE

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The American Academy of Neurology is an association of more than 22,500 neurologists and neuroscience professionals.  A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

A new guideline from the American Academy of Neurology recommends using plasma exchange to treat people with severe relapses in multiple sclerosis (MS) and related diseases, as well as those with certain kinds of nerve disorders known as neuropathies. The guideline is published in the January 18, 2011, print issue of Neurology, the medical journal of the American Academy of Neurology.  Evidence-based guideline update: Plasmapheresis in neurologic disorders; Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, I. Cortese, MD, V. Chaudhry, MD, Y.T. So, MD, PhD, F. Cantor, MD, D.R. Cornblath, MD, A. Rae-Grant, MD, Neurology 2011;76:294–300.

The objective was to reassess the role of plasmapheresis in the treatment of neurologic disorders.  The authors evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009.

Plasma exchange, also known as plasmapheresis, is the process of taking blood out of the body, removing constituents in the blood’s plasma thought to be harmful, and then transfusing the rest of the blood (mainly red blood cells) mixed with replacement plasma back into the body.  Plasma is the liquid part of blood. The solid parts are white and red blood cells.  In plasma exchange, blood is drawn from the person.  The plasma is separated from the solid parts of the blood.  It is then replaced with plasma from a plasma donor.  The donor plasma is pumped into the person. A machine sends the plasma through a tube into the body.  If no donated plasma is available, albumin solution can be used. Albumin is an important protein in plasma.  Like any medical procedure, plasma exchange poses some risks.  It is invasive. This means it involves an object—in this case, a tube—entering the body. Side effects of plasma exchange include infection and blood-clotting issues. You should discuss the benefits and risks of this treatment with your doctor.

The guideline recommends doctors consider using plasma exchange as a secondary treatment for severe flares in relapsing forms of MS and related diseases. The treatment was not found to be effective for secondary progressive and chronic progressive forms of MS. According to the guideline, doctors should offer plasma exchange for treatment of severe forms of Guillain-BarrĂ© syndrome and for temporary treatment of chronic inflammatory demyelinating polyneuropathy. Plasma exchange may also be considered for treatment of some other kinds of inflammatory neuropathies.  These types of neurologic disorders occur when the body’s immune system mistakenly causes damage to the nervous system. Plasma exchange helps because it removes factors in the plasma thought to play a role in these disorders.  The guideline authors also looked at the use of plasma exchange for other neurologic disorders, including myasthenia gravis and pediatric autoimmune neuropsychiatric disorders (PANDAS), but there was not enough evidence to determine whether it is an effective treatment.





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