Plasma exchange in the management of acute polyradiculopathy and myasthenic crisis (plasma exchange in neurological disorders).

Six patients with acute severe neurological illnesses were managed by plasma exchange on the basis that their diseases were triggered by immune mechanisms. These included one case of acute post-infectious encephalomyeloradiculopathy, two cases of Guillain Barré Syndrome or acute polyradiculoneuropathy and three patients in myasthenic crisis. There were no convincing responses in the patients with Guillain Barré Syndrome. All three myasthenic patients showed improvement that was sufficiently dramatic to warrant continued use of this therapeutic procedure. Based on our experience and reports by others it is felt that in acute polyradiculoneuropathy plasmapheresis would be beneficial only if the disease is predictably deteriorating and should be done within the first few days. In myasthenic crises its role is more definite and it shortens significantly the duration of assisted ventilation and the length of severe relapse. The procedure also gives the physician sufficient time to effectively immunosuppress the patients.