Plasmaferese em neurologia análise crítica da indicação e protocolos

Seggia, José Carlos Brant; Abreu, Paulo

doi:10.1590/S0004-282X1992000300011

Resumos

Por ser a plasmaferese método terapêutico moderno e seguro, ela é cada vez mais indicada em doenças ligadas etiopatogenicamente à imunologia. Propomo-nos analisar suas indicações no âmbito da neurologia. Discutimos e analisamos sua indicação em miastenia grave, esclerose em placas, síndrome de Guillain-Barré, dermato e polimiosite, polineuropatia desmielinizante inflamatória crônica, paraproteinemias, paraplegia espástica tropical, neuropatia periférica e mielopatia por HIV. Sugerimos esquemas para a execução do método em algumas doenças e apresentamos, de maneira resumida, nossa casuística.

plasmaferese; doenças do sistema nervoso; avaliação; protocolo

Therapeutic plasmapheresis (plasma exchange) in neurology is a matter of discussion. We review the main articles on clinical trials, both controlled land uncontrolled, trying to establish the efficacy and safety of the procedure. Humoral aspects involved in the genesis of the disorder play an important role for its indication in the present time. In myasthenia gravis indications for plasmapheresis are established: in the preparation for thymectomy, in patients with respiratory insufficiency and requiring respiratory protesis, after long immunossupression therapy with rebound effect, when all other forms of therapy failed, and in neonatal myasthenia gravis with special technics. We discuss the indication of plasmapheresis in Guillain-Barré syndrome, multiple sclerosis, chronic inflammatory demyelinating poly-neuromyelopathy, HTDV-1 myelopathy, HIV peripheral neuropathy and myelopathy, paraproteinemias, polymyositis, and dermatomyositis. Indications for other diseases are mentioned. Reference is made to the results we observed in 31 cases followed consecutively at Hospital dos Servidores, Rio de Janeiro, from June 1984 to June 1990. In our series 26 were myasthenic patients, 4 patients presented Guillain-Barré syndrome, and 1 multiple sclerosis. Therapeutic plasmapheresis protocols suggested by us are summarized.

plasmapheresis (plasma exchange); disorders of the nervous system; evaluation; protocol

Plasmaferese em neurologia análise crítica da indicação e protocolos

Plasmapheresis in neurology: a critical analysis of the indication and protocols

José Carlos Brant Seggia^I; Paulo Abreu^II

^IMembro do Serviço de Neurologia. Hospital dos Servidores do Estado INAMPS-RJ

^IIMembro do Serviço de Clínica Médica, Setor de Nefrologia. Hospital dos Servidores do Estado INAMPS-RJ:

RESUMO

Por ser a plasmaferese método terapêutico moderno e seguro, ela é cada vez mais indicada em doenças ligadas etiopatogenicamente à imunologia. Propomo-nos analisar suas indicações no âmbito da neurologia. Discutimos e analisamos sua indicação em miastenia grave, esclerose em placas, síndrome de Guillain-Barré, dermato e polimiosite, polineuropatia desmielinizante inflamatória crônica, paraproteinemias, paraplegia espástica tropical, neuropatia periférica e mielopatia por HIV. Sugerimos esquemas para a execução do método em algumas doenças e apresentamos, de maneira resumida, nossa casuística.

Palavras-chave: plasmaferese, doenças do sistema nervoso, avaliação, protocolo.

SUMMARY

Therapeutic plasmapheresis (plasma exchange) in neurology is a matter of discussion. We review the main articles on clinical trials, both controlled land uncontrolled, trying to establish the efficacy and safety of the procedure. Humoral aspects involved in the genesis of the disorder play an important role for its indication in the present time. In myasthenia gravis indications for plasmapheresis are established: in the preparation for thymectomy, in patients with respiratory insufficiency and requiring respiratory protesis, after long immunossupression therapy with rebound effect, when all other forms of therapy failed, and in neonatal myasthenia gravis with special technics. We discuss the indication of plasmapheresis in Guillain-Barré syndrome, multiple sclerosis, chronic inflammatory demyelinating poly-neuromyelopathy, HTDV-1 myelopathy, HIV peripheral neuropathy and myelopathy, paraproteinemias, polymyositis, and dermatomyositis. Indications for other diseases are mentioned. Reference is made to the results we observed in 31 cases followed consecutively at Hospital dos Servidores, Rio de Janeiro, from June 1984 to June 1990. In our series 26 were myasthenic patients, 4 patients presented Guillain-Barré syndrome, and 1 multiple sclerosis. Therapeutic plasmapheresis protocols suggested by us are summarized.

Key words: plasmapheresis (plasma exchange), disorders of the nervous system, evaluation, protocol.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. José Carlos Brant Seggia - Av. Almirante Ary Parreiras 659 - 24230 Niterói RJ - Brasil.

1. Abel JJ, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmaocl Exp Ther 1914, 283-284.
2. Avangelista GM, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmacol Exp Ther 1987, 295:283-284.
3. Baeukchine S, Mas JL, Rottembourg R. Polyneuropathy as the first sign of a primary Sjogren's syndrome: treatment by plasmatic exchanges. Rev. Neurol (Paris) 1987, 143:839-840.
4. Behan PO, Behan WMH. Plasma exchange in neurological diseases. Br Med J 1987, 295:283-284.
5. Council on scientific affairs. Current status of therapeutic plasmapheresis and related techniques. JAMA 1985, 253:819-824.
6. Dau PC. Plamapheresis in idiopathic inflammatory myophaty: experience with 35 patients. Arch Neurol 1981, 38:544-552.
⁷
Frenche Cooperative Group on plasma exchange and Guillain Barré syndrome. Efficiency of plasma exchange in Guillain-Barré Syndrome: role of replacement fluids. Ann Neurol 1987, 22:753-761.
8. Gordon PA, Carroll DJ, Etches WS, Jeffrey V. Marsh L, Morrice BL, Olmstead D, Warren K. A double-blind controlled pilot study of plasma exchange versus sham apheresis in chronic progressive multiple sclerosis. Can J Neurol Sci 1985, 12:30-44.
9. Guillain-Barré Syndrome Study Group. Plasmapheresis and acute Guillan-Barré syndrome. Neurology 1985, 35:1096-1104.
10. Haas DC, Tatum AH. Plasmapheresis alleviates neuropathy accompanying IgM anti-myelin-associated glycoprotein paraproteinemia. Ann Neurol 1988, 23:394-396.
11. Herson S, Lok C, Gerard A. Plasma exchange for dermatomyositis and polymyositis: retrospective study of 41 courses of plasma exchange. Plasma Ther Transfers Teehnol 1987, 8:127-130.
12. Hida M, Takamiya T, Kitamura M, Ilda T, Kitajima N, Hiraga S, Satoh T. Clinical reports on plasma exchange in the Kidney Center, Tokai University School of Medicine. Tokai J Exp Clin Med 1987, 12:61-66.
13. Jauregui WO, Digressia C, Herrera ME, Muchanick S. Plasmaferesis en miastenia grave. Medicina (Buenos Aires) 1981, 41:511-519.
14. Khatri BO. Experience with use of plasmapheresis in chronic progressive multiple sclerosis. Neurology 1988, 38(Suppl 2) :50-52.
15. Kiprov D, Pfaeffl W, Parry G, Lippert R, Lang W, Miller R. Antibody-mediated peripheral neuropathies associated with ARC and AIDS: successful treatment with plasmapheresis. J Clin Apheresis 1988, 4 :3-7.
16. Kiprov DD, Simpson DM, Pfaeffl W, Romanick-Schmiedl S, Abrams P, Miller RG. AIDS and apheresis procedures: therapeutic and safety considerations. Blood Purif 1987, 8:23-29.
17. Koski C, Gratz E, Sutherland J, Mayer RJ. Clinical correlation with antiperipheral-nerve myelin antibodies in Guillan Barré syndrome. Ann Neurol 1986, 19:573-577.
18. Marchiori PE, Scaff M, Mello EP, Trindade VS,, Assis SL. Plasmaferese sem imunosu-pressáo concomitante em miastenia gravis: relato de caso. Rev Hosp Clin Fac Med Univ S Paulo 1981, 36:278-281.
19. Matsue H, Nakamura T, Tsugihata M, Satoh A, Tomita I, Shirabe S, Shibayama K, Na-gataki S. Plasmapheresis in treatment of human T-lymphotropic virus type I. associated myelophaty. Lancet 1988, 2:1109-1113.
20. McKhann GM, Griffin JW. Plasmapheresis and the Guillain-Barré syndrome. Ann Neurol 1987, 22:762-763.
21. McKhann GM, Griffin JW, Cornblath DR. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol 19S8, 23 :347-353.
22. Morgan OS, Willians W. Plasmapheresis in the Guillain Barré syndrome: a preliminary report. West Indian Med J 1983, 32:248-250.
23. NIH Consensus Development Conference Consensus Statement. The utility of therapeutic plasmapheresis for neurological disorders. JAMA 1986, 256:333-337.
24. Osterman PO, Fagius J, Säfwenberg J, Wikstr5m B. Early relapse of acute inflammatory polyradiculoneuropathy after successfull treatment with plasma exchange. Acta Neurol Scand 1988, 77: 273-277.
25. Snead OC, Kohaut EC, Oh SJ, Bradley RJ. Clinical and laboratory observations: Plasmapheresis for myasthenic crisis in a young child. J Pediatr 1987, 110:740-742.
26. Tindall R. A closer look at plasmapheresis in multiple sclerosis. Neurology 1988, 38 (Suppl 2):53-56.
27. Tindall RSA, Humorad factors in inflammatory disorders of central and peripheral nervous system. J Neuroimmunol 1988, 20:283-296.
28. Vigari AM, Folli F, Pozza G, Coni GC, Comola M, Canal N, Besana C, Boni A, Tresoldi M, Solimena M. Plasmapheresis in the treatment of stiff-man syndrome. N Engl J Med 1989, 320:1499.
29. Wirguin I, Shinar E, Abramsky O. Relapse of multiple sclerosis following acute allergic reactions to plasma during plasmapheresis. J Neurol 1989, 236:62-63.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abel JJ, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmaocl Exp Ther 1914, 283-284.

[2] 2. Avangelista GM, Rowntree LG, Turner BB. Plasma removal with return of corpuscles (plasmapheresis). J Pharmacol Exp Ther 1987, 295:283-284.

[3] 3. Baeukchine S, Mas JL, Rottembourg R. Polyneuropathy as the first sign of a primary Sjogren's syndrome: treatment by plasmatic exchanges. Rev. Neurol (Paris) 1987, 143:839-840.

[4] 4. Behan PO, Behan WMH. Plasma exchange in neurological diseases. Br Med J 1987, 295:283-284.

[5] 5. Council on scientific affairs. Current status of therapeutic plasmapheresis and related techniques. JAMA 1985, 253:819-824.

[6] 6. Dau PC. Plamapheresis in idiopathic inflammatory myophaty: experience with 35 patients. Arch Neurol 1981, 38:544-552.

[7] ⁷
Frenche Cooperative Group on plasma exchange and Guillain Barré syndrome. Efficiency of plasma exchange in Guillain-Barré Syndrome: role of replacement fluids. Ann Neurol 1987, 22:753-761.

[8] 8. Gordon PA, Carroll DJ, Etches WS, Jeffrey V. Marsh L, Morrice BL, Olmstead D, Warren K. A double-blind controlled pilot study of plasma exchange versus sham apheresis in chronic progressive multiple sclerosis. Can J Neurol Sci 1985, 12:30-44.

[9] 9. Guillain-Barré Syndrome Study Group. Plasmapheresis and acute Guillan-Barré syndrome. Neurology 1985, 35:1096-1104.

[10] 10. Haas DC, Tatum AH. Plasmapheresis alleviates neuropathy accompanying IgM anti-myelin-associated glycoprotein paraproteinemia. Ann Neurol 1988, 23:394-396.

[11] 11. Herson S, Lok C, Gerard A. Plasma exchange for dermatomyositis and polymyositis: retrospective study of 41 courses of plasma exchange. Plasma Ther Transfers Teehnol 1987, 8:127-130.

[12] 12. Hida M, Takamiya T, Kitamura M, Ilda T, Kitajima N, Hiraga S, Satoh T. Clinical reports on plasma exchange in the Kidney Center, Tokai University School of Medicine. Tokai J Exp Clin Med 1987, 12:61-66.

[13] 13. Jauregui WO, Digressia C, Herrera ME, Muchanick S. Plasmaferesis en miastenia grave. Medicina (Buenos Aires) 1981, 41:511-519.

[14] 14. Khatri BO. Experience with use of plasmapheresis in chronic progressive multiple sclerosis. Neurology 1988, 38(Suppl 2) :50-52.

[15] 15. Kiprov D, Pfaeffl W, Parry G, Lippert R, Lang W, Miller R. Antibody-mediated peripheral neuropathies associated with ARC and AIDS: successful treatment with plasmapheresis. J Clin Apheresis 1988, 4 :3-7.

[16] 16. Kiprov DD, Simpson DM, Pfaeffl W, Romanick-Schmiedl S, Abrams P, Miller RG. AIDS and apheresis procedures: therapeutic and safety considerations. Blood Purif 1987, 8:23-29.

[17] 17. Koski C, Gratz E, Sutherland J, Mayer RJ. Clinical correlation with antiperipheral-nerve myelin antibodies in Guillan Barré syndrome. Ann Neurol 1986, 19:573-577.

[18] 18. Marchiori PE, Scaff M, Mello EP, Trindade VS,, Assis SL. Plasmaferese sem imunosu-pressáo concomitante em miastenia gravis: relato de caso. Rev Hosp Clin Fac Med Univ S Paulo 1981, 36:278-281.

[19] 19. Matsue H, Nakamura T, Tsugihata M, Satoh A, Tomita I, Shirabe S, Shibayama K, Na-gataki S. Plasmapheresis in treatment of human T-lymphotropic virus type I. associated myelophaty. Lancet 1988, 2:1109-1113.

[20] 20. McKhann GM, Griffin JW. Plasmapheresis and the Guillain-Barré syndrome. Ann Neurol 1987, 22:762-763.

[21] 21. McKhann GM, Griffin JW, Cornblath DR. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol 19S8, 23 :347-353.

[22] 22. Morgan OS, Willians W. Plasmapheresis in the Guillain Barré syndrome: a preliminary report. West Indian Med J 1983, 32:248-250.

[23] 23. NIH Consensus Development Conference Consensus Statement. The utility of therapeutic plasmapheresis for neurological disorders. JAMA 1986, 256:333-337.

[24] 24. Osterman PO, Fagius J, Säfwenberg J, Wikstr5m B. Early relapse of acute inflammatory polyradiculoneuropathy after successfull treatment with plasma exchange. Acta Neurol Scand 1988, 77: 273-277.

[25] 25. Snead OC, Kohaut EC, Oh SJ, Bradley RJ. Clinical and laboratory observations: Plasmapheresis for myasthenic crisis in a young child. J Pediatr 1987, 110:740-742.

[26] 26. Tindall R. A closer look at plasmapheresis in multiple sclerosis. Neurology 1988, 38 (Suppl 2):53-56.

[27] 27. Tindall RSA, Humorad factors in inflammatory disorders of central and peripheral nervous system. J Neuroimmunol 1988, 20:283-296.

[28] 28. Vigari AM, Folli F, Pozza G, Coni GC, Comola M, Canal N, Besana C, Boni A, Tresoldi M, Solimena M. Plasmapheresis in the treatment of stiff-man syndrome. N Engl J Med 1989, 320:1499.

[29] 29. Wirguin I, Shinar E, Abramsky O. Relapse of multiple sclerosis following acute allergic reactions to plasma during plasmapheresis. J Neurol 1989, 236:62-63.