Evidence-based guideline update: Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

I. Cortese, Vinay Chaudhry, Y. T. So, F. Cantor, David Cornblath, A. Rae-Grant

Research output: Contribution to journalArticle

Abstract

Objective: To reassess the role of plasmapheresis in the treatment of neurologic disorders. Methods: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Results and recommendations: Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U).

Original languageEnglish (US)
Pages (from-to)294-300
Number of pages7
JournalNeurology
Volume76
Issue number3
DOIs
StatePublished - Jan 18 2011

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Biomedical Technology Assessment
Plasmapheresis
Nervous System Diseases
Guidelines
Chronic Progressive Multiple Sclerosis
Guillain-Barre Syndrome
Therapeutics
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Chorea
Manuscripts
Central Nervous System Diseases
Myasthenia Gravis
Demyelinating Diseases
Streptococcus
Immunoglobulin A
Multiple Sclerosis
Immunoglobulin M
Publications
Immunoglobulin G
Steroids

ASJC Scopus subject areas

  • Clinical Neurology

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Evidence-based guideline update : Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. / Cortese, I.; Chaudhry, Vinay; So, Y. T.; Cantor, F.; Cornblath, David; Rae-Grant, A.

In: Neurology, Vol. 76, No. 3, 18.01.2011, p. 294-300.

Research output: Contribution to journalArticle

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