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Plasmapheresis in multiple sclerosis

Preliminary findings

Paul M. Aggeler Memorial Laboratory, Children's Hospital of San Francisco (Dr. Dau), the Departments of Medicine (Dr. Dau) and Neurology (Drs. Johnson and Panitch), University of California, San Francisco, the Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT (Dr. Petajan), and the Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (Dr. Bornstein).

In seven of eight patients with progressive multiple sclerosis subjected to long-term plasmapheresis in combination with azathioprine and pulsed prednisone therapy, we found modest improvement of neurologic function. There was no change in auditory and visual evoked responses or serum demyelinating activity. In six of seven patients, cerebrospinal fluid IgG content decreased. Three additional patients in acute, severe exacerbation refractory to prednisone therapy made a substantial recovery, which commenced with plasmapheresis therapy. In two of them, the onset of clinical improvement after plasmapheresis was corroborated by decreased latency or increased amplitude of somatosensory evoked potentials.

These results suggest that blood-borne factors, possibly autoantibodies, may play a role in the pathogenesis of the disease. The lesions may be at least partially reversible with plasmapheresis therapy, but a controlled trial is necessary to confirm these preliminary findings.

This investigation was supported in part by grants from the Kroc Foundation, the National Multiple Sclerosis Society (Nos. RG1008 and RG1227-A7), the National Institutes of Health (No. NS11920), and the Muscular Dystrophy Association.

Address correspondence and reprint requests to Dr. Dau, Children's Hospital of San Francisco, Paul M. Aggeler Memorial Laboratory, P. O. Box 3805, San Francisco, CA 94119.

Accepted for publication February 21, 1980.

Presented in part at the Workshop on Therapeutic Plasma and Cytapheresis, Rochester, MN, April 1979, and at the thirty-first annual meeting of the American Academy of Neurology, Chicago, April 1979.

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