Plasma Exchange in Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Peter James Dyck, Jasper Daube, Peter O'brien, Alvaro Pineda, Phillip A. Low, Anthony J. Windebank, Carol Swanson

Research output: Contribution to journalArticle

412 Scopus citations

Abstract

Plasma exchange has been reported to be efficacious in chronic inflammatory demyelinating polyradiculoneuropathy. We performed a prospective double-blind trial in which patients with static or worsening disease were randomly assigned to plasma exchange (n = 15) or to sham exchange (n = 14) for three weeks. After three weeks, we observed statistically significant differences in combined measurements of nerve conduction (total, motor, proximal, velocity, and amplitude) favoring patients who had received plasma exchange. Improvement to a greater degree than for any patient receiving sham exchange was detected in the neurologic-disability score in five patients (P = 0.025) and in subset scores for weakness and reflex in four patients (P<0.057). We conclude that for some patients with chronic inflammatory demyelinating polyradiculoneuropathy, plasma exchange has an ameliorating effect on neurologic dysfunction and nerve conduction, but in others no improvement is observed. Because plasma was replaced with normal serum albumin, a humoral factor or factors may have a role in the neurologic deficit of this disorder. (N Engl J Med 1986; 314: 461–5.), CHRONIC inflammatory demyelinating polyradiculoneuropathy is increasingly being distinguished from acute inflammatory demyelinating polyradiculoneuropathy (Guillain–Barré syndrome) 1 2 3 4 5 6 and from a variety of disease-associated polyradiculoneuropathies (inherited disorders, myeloma, leukemia, lymphomas, cancers, diabetes mellitus, and hepatic disease). Chronic inflammatory demyelinating polyradiculoneuropathy is now being distinguished from the acute disease because the course and prognosis are different, a high rate of preceding viral infections has been found only in the acute disease, an HLA association has been found only in the chronic disease, and management and therapy may need to be different. Chronic inflammatory demyelinating polyradiculoneuropathy is a chronic neuropathy thought to be mediated by…

Original languageEnglish (US)
Pages (from-to)461-465
Number of pages5
JournalNew England Journal of Medicine
Volume314
Issue number8
DOIs
StatePublished - Feb 20 1986

ASJC Scopus subject areas

  • Medicine(all)

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