Plasma exchange for Multiple Sclerosis

Overview
Plasma exchange, also known as plasmapheresis, is a short-term treatment for acute exacerbations in some people with relapsing forms of multiple sclerosis (MS). In 2011, the American Academy of Neurology (AAN) issued a new guideline recommending plasma exchange as an alternative, secondary treatment for people whose flare-ups were not responding well to high doses of corticosteroids, or who cannot tolerate drug therapy. The AAN stated that people who do respond well to corticosteroids should not be considered for plasma exchange. Plasma exchange is not an effective treatment for progressive forms of MS.

What does it involve?
Plasma exchange involves replacing the plasma, or liquid, part of your blood with either albumin (a liquid protein made in the human body) or plasma from a donor. Only the plasma is removed; your red and white blood cells are combined with the replacement plasma and returned to your body. It is thought that plasma exchange works to combat severe MS flare-ups by removing inflammatory factors such as antibodies and preventing them from attacking your nervous system.

Plasma exchange must be received in a dedicated clinical setting. A medical professional will insert a needle and tube into your arm and attach the tubing to a special machine that performs the exchange. Each treatment requires two to four hours. Typically, people receiving plasma exchange for MS flare-ups undergo between three and seven treatments.

Intended Outcomes
The goal of plasma exchange treatment is to reduce neurological disabilities during severe MS flare-ups.

Results
In a 1999 study, 36 people experiencing acute MS flare-ups and who failed to improve with intravenous corticosteroids were either given plasma exchange or a sham treatment. Of the 19 people who received plasma exchange, eight showed moderate or better improvement in neurological deficits. Only one person of the 17 who received the sham treatment experienced similar improvements during the treatment period.

Constraints
Plasma exchange can be a time-consuming and expensive procedure. Your insurance may or may not cover plasma exchange.

A very small number of people experience infections or bleeding due to the procedure of plasma exchange. Some people may have allergic reactions to albumin, which may be used as the replacement liquid for plasma, or to the chemicals used to sterilize the tubing. Some people may experience dizziness, fainting or nausea during plasma exchange; drinking extra water starting three days before the treatment can help combat these side effects.

Plasma exchange may cause a drop in levels of calcium in the blood due to the use of the blood thinner citrate. Ask your doctor about taking a calcium supplement when receiving plasma exchange.

Seek medical help immediately if you experience symptoms of an allergic reaction such as trouble breathing, severe dizziness, a rash, or itching or swelling of the face, tongue and throat.