Therapeutic plasma exchange in the neurologic intensive care setting recommendation for clinical practice

Therapeutic plasma exchange (TPE) is a well-established therapeutic procedure commonly used in many neurologic immune-mediated disorders. It is thought that the beneficial effects of TPE occur through elimination of pathognomonic autoantibodies, immune complexes, inflammatory mediators, complement components and cytokines, which play a crucial role in many kinds of neurologic autoimmune disease. In various neurologic disorders, randomized controlled studies have demonstrated the efficacy of TPE (e.g., in acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome), chronic inflammatory demyelinating polyradiculoneuropathy, myasthenia gravis and paraproteinemic polyneuropathies). For these disorders, TPE is accepted as first-line therapy, either as a primary standalone treatment or in conjunction with other modes of treatment. Although widely used, the potential benefit of TPE in the treatment of acute disseminated encephalomyelitis, chronic focal encephalitis (Rasmussen's encephalitis), Lambert-Eaton myasthenic syndrome, multiple sclerosis and neuromyelitis optica (Devic's disease) is less clear. For these disorders, TPE is accepted as second-line therapy, either as a standalone treatment or in conjunction with other modes of treatment.