[Plasmapheresis, immunotherapy and chemotherapy in polyneuropathies]

Although the precise cause of many of the polyneuropathies evaluated clinically is unknown, there is substantial evidence that many are caused by autoimmune disorders. Currently treatment is directed towards production of immunomodulation or immunosuppression.

The degree of subjective symptoms such as fatigue, pain or other sensory symptoms are not good criteria for determination of the need for immunosuppressive treatment. Treatment should be orientated towards serious neuropathic defects, not minimal deficits. It is therefore important to record the defect precisely, so as to be able to determine objectively the effect of therapy. For this, tables or diagrams using established scales, such as that of the Medical Research Council, are recommended. Similarly, evaluation and follow-up by the physical therapy and occupational therapy departments should be considered when deciding the treatment to be used for autoimmune neuropathies such as corticosteroids, plasmapheresis, ev immunoglobulin, cytopathic agents and alpha interferon.