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