Experience with use of plasmapheresis in chronic progressive multiple sclerosis: the pros.

Based on the assumptions that multiple sclerosis (MS) is an autoimmune disorder and that plasmapheresis (PP) is an effective means of removing antibodies and other proteins from the circulation, several uncontrolled studies were undertaken to ascertain the role of PP in MS. Since MS is a chronic and persistent rather than monophasic illness, PP has been used in MS in conjunction with a variety of immunosuppressive drug regimens, theoretically to prevent the rebound reformation of the offending protein being removed. Careful analysis of the uncontrolled studies shows wide variance in the types of patients treated; the extent, duration and activity of their disease; and the methodology of PP and the adjunctive immunosuppressive treatment. Nevertheless, the conclusion we reached from this analysis was that prolonged treatment with PP, in conjunction with corticosteroid and other immunosuppressive drug treatment, may have a major clinical effect in patients severely disabled with chronic progressive MS. This in itself is a remarkable conclusion, since it is drawn from data about a form of MS which, by definition, rarely if ever improves spontaneously: more than one-half of the patients reported improvement.