Neurol. praxi. 2011;12(6):394-397

Therapeutic plasma exchange in the treatment of autoimmune neuromuscular disordes

prof.MUDr.Josef Bednařík, CSc.

Neurologická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno

The aim of therapeutic plasma exchange (TPE) is to remove pathological (autoantibodies, monoclonal proteins, toxins bound to plasma

proteins) or increased physiological plasma components (cytokins, kinins). Among neurological diseases, TPE is the accepted first-line

therapy (according to American Society for Apheresis [ASFA] – category I) in PANDAS („Pediatric Autoimmune Neuropsychiatric Disorders

Associated with streptoccal infections and Sydenham’s chorea“), and the second-line therapy (category II) in acute disseminated

encephalomyelitis, multiple sclerosis, Devic disease and some paraneoplastic neurological syndromes with autoantibodies.

Autoimmune neuromuscular disorders, however, are the most frequent indications for TPE in neurology: myasthenia gravis (MG), Guillain-

Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP) and paraproteinaemic polyneuropathy IgG/IgA are

classified as category I (acc. to ASFA), and Lambert-Eaton myastenic syndrome (LEMS) and acquired neuromyotonia as category II.

Guidelines of the European Federation of Neurology, the American Academy of Neurology and the Czech Neurological Society, however,

consider TPE as the first-line therapy in GBS and MG only (as the alternative method to intravenous humane immunoglobulin [IVIG] that

has more favourable safety profile), while TPF is recommended as the second-line therapy in CIDP, and the evidence of the TPE effect in

paraproteinaemic polyneuropathies and LEMS is lacking.

Keywords: plazma exchange, autoantibodies, myasthenia gravis, Guillain-Barré syndrome

Published: December 1, 2011  Show citation