Plasma Exchange in Neurologic Diseases

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Abstract
Plasma exchange has become increasingly popular as a mode of therapy in putative immunopathologic diseases of man, including several disorders of interest to neurologists. Among these are myasthenia gravis (MG), demyelinative neuropathies (acute, relapsing, and chronic progressive), inflammatory myopathies, Eaton-Lambert syndrome (ELS), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). Despite, or perhaps because of, the intense interest in and enthusiasm for this form of therapy, firm evidence of therapeutic efficacy in neurologic diseases is limited to MG. In this article, I will review the use and rationale for plasma exchange in these neurologic disorders and outline my personal view of the current role and use of plasma exchange in these diseases. MG Myasthenia gravis can be considered a prototype antibody-mediated autoimmune disease in which the pathogenesis of neuromuscular weakness can be attributed to a decrease in available nicotinic receptors for acetylcholine at the muscle end-plate.1-4 This decrease is