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January 18, 2011; 76 (3) Special Article

Evidence-based guideline update: Plasmapheresis in neurologic disorders

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

I. Cortese, V. Chaudhry, Y.T. So, F. Cantor, D.R. Cornblath, A. Rae-Grant
First published January 17, 2011, DOI: https://doi.org/10.1212/WNL.0b013e318207b1f6
I. Cortese
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V. Chaudhry
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Y.T. So
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F. Cantor
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D.R. Cornblath
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A. Rae-Grant
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Citation
Evidence-based guideline update: Plasmapheresis in neurologic disorders
Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
I. Cortese, V. Chaudhry, Y.T. So, F. Cantor, D.R. Cornblath, A. Rae-Grant
Neurology Jan 2011, 76 (3) 294-300; DOI: 10.1212/WNL.0b013e318207b1f6

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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).

Footnotes

  • Supplemental data at www.neurology.org

  • Appendices e-1–e-4 and table e-1 are available on the Neurology® Web site at www.neurology.org.

  • Approved by the Therapeutics and Technology Assessment Subcommittee on February 6, 2010; by the Practice Committee on June 28, 2010; and by the AAN Board of Directors on October 18, 2010.

  • AAN
    American Academy of Neurology
    ADEM
    acute disseminated encephalomyelitis
    AIDP
    acute inflammatory demyelinating polyneuropathy
    CI
    confidence interval
    CIDP
    chronic inflammatory demyelinating neuropathy
    CMAP
    compound muscle action potential
    GBS
    Guillain-Barré syndrome
    IgA
    immunoglobulin A
    IgG
    immunoglobulin G
    IgM
    immunoglobulin M
    IVIg
    IV immunoglobulin
    MG
    myasthenia gravis
    MGUS
    monoclonal gammopathy of undetermined significance
    MS
    multiple sclerosis
    NDS
    Neuropathy Disability Scale
    NMO
    neuromyelitis optica
    OCD
    obsessive-compulsive disorder
    PANDAS
    pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection
    TM
    transverse myelitis
    TTA
    Therapeutics and Technology Assessment.

  • Received June 28, 2010.
  • Accepted October 18, 2010.
  • Copyright © 2011 by AAN Enterprises, Inc.
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Disputes & Debates: Rapid online correspondence

  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Carisa Freeman, stay at home mother, patientcarisaf@sbcglobal.net
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Melinda M. Winter, Researcher, Nonewmelinda2011@aol.com
    Submitted July 05, 2011
  • Reply from the authors to Winter, Freeman, and three patients
    • Irene Cortese, Vinay Chaudhry, David Cornblath, Yuen So, Fredric Cantorguidelines@aan.com
    • V. Chaudhry, Baltimore, MD; D. Cornblath, Baltimore, MD; Y. So, Palo Alto, CA; F. Cantor, Bethesda
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Joseph Schwartz, M.D. Chair, ASFA Applications Committee for the Members of the Guidelines Subcommittee., Columbia University Medical Center, New York, NYjs2745@columbia.edu
    Submitted July 05, 2011
  • Reply from the authors to Dr. Schwartz
    • Irene Cortese, guidelines@aan.com
    • V. Chaudhry, Baltimore, MD; D. Cornblath, Baltimore, MD; Y. So, Palo Alto, CA; F. Cantor, Bethesda
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Bhupendra O. Khatri, Director, Center for Neurological Disorders, Aurora Health Care, St. Luke's Medical Center, Milwaukee WIbokhatri@aol.com
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Michael P. McQuillen, Clinical Professor of Neurology, Stanford, CAmichael_mcquillen@comcast.net
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Henry Kaminski, Saint Louis University, St. Louis, MOhkaminsk@slu.edu
    • Henry Kaminski, Gary Cutter, Robert L. Ruff, and Gil Wolfe
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Abraham CJ Stork, MD, Polyneuropathy Expertise Ctr, Dept of Neurology, Rudolf Magnus Inst of Neuroscience, Utrecht, Nethastork@umcutrecht.nl
    • Nicolette C Notermans, Alexander FJE Vrancken, Leonard H van den Berg and W-Ludo van der Pol
    Submitted July 05, 2011
  • Evidence-based guideline update: Plasmapheresis in neurologic disorders
    • Farrah J. Mateen, Neurologist/Fellow, Johns Hopkins Universityfmateen@jhsph.edu
    • Alexander Zubkov, RajaNandini Muralidharan, George Petty, Jeffrey Winters.
    Submitted July 05, 2011
  • Reply from authors to Khatri, McQuillen, Kaminski et al., Stork et al., and Mateen et al.
    • Irene Cortese, guidelines@aan.com
    • V. Chaudhry, Baltimore, MD; D. Cornblath, Baltimore, MD; Y. So, Palo Alto, CA; F. Cantor, Bethesda
    Submitted July 05, 2011
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