Therapeutic Plasma Exchange in Neurological Disorders

Therapeutic plasma exchange (TPE) is an extracorporeal procedure that separates and replaces patient plasma to remove pathogenic factors implicated in autoimmune neurological conditions. By extracting circulating autoantibodies, immune complexes and inflammatory mediators, TPE is employed as an adjunctive or rescue therapy for steroid-refractory relapses in multiple sclerosis, neuromyelitis optica spectrum disorder (NMOSD) and chronic inflammatory demyelinating polyradiculoneuropathy. Clinical protocols typically involve five to seven exchanges over one to two weeks, with replacement fluids comprising albumin or pooled plasma. Earlier initiation of TPE often correlates with more rapid neurological recovery and greater reduction in disability scores. While the technique is generally well tolerated, potential complications include hypotension, bleeding diathesis and allergic reactions, necessitating vigilant monitoring. Ongoing research seeks to refine patient selection criteria, optimise exchange parameters and illuminate immunological mechanisms beyond simple antibody depletion, thereby enhancing therapeutic efficacy and long-term outcomes.

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Therapeutic Plasma Exchange in Neurological Disorders publication trend

The graph below shows the total number of articles in therapeutic plasma exchange in neurological disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Therapeutic plasma exchange (TPE): An apheresis technique in which plasma is removed and replaced to eliminate pathogenic substances such as autoantibodies.

Autoantibody: An antibody produced by the immune system that mistakenly targets an individual’s own tissues or organs.

Neuromyelitis optica spectrum disorder (NMOSD): An autoimmune condition characterised by recurrent optic neuritis and longitudinally extensive myelitis, often associated with aquaporin-4 antibodies.

Expanded Disability Status Scale (EDSS): A measure of neurological disability in multiple sclerosis and related disorders, scored from 0 (normal) to 10 (death due to disease).

References

1. The Role of Plasma Exchange in the Treatment of Refractory Autoimmune Neurological Diseases: a Narrative Review. Journal of Neuroimmune Pharmacology (2021).
2. Immunomodulatory Aspects of Therapeutic Plasma Exchange in Neurological Disorders—A Pilot Study. International Journal of Molecular Sciences (2023).
3. Safety and efficacy of plasma exchange treatment in children with AQP4-IgG positive neuromyelitis optica spectrum disorder. Frontiers in Immunology (2023).
4. Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study. Journal of Neuroinflammation (2022).