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Therapeutic Apheresis in Neurology Critical Care

Neela Natarajan, MD

Department of Medicine, Caritas St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA

Robert Weinstein, MD

Department of Medicine, Caritas St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, rweinstein{at}cchcs.org

Therapeutic apheresis has been widely accepted in the treatment of neurological disorders that are understood to be mediated by humoral and/or cellular immunity. The clinical presumption is that well-established and/or unknown insults cause damage to nerves or their myelin sheaths. The rationale for apheresis treatments for these neurological disorders relates to removal of offending immune (or other) mediators, thus blunting the attack and permitting recovery of nerve and/or myelin. This review will concentrate on the role of therapeutic apheresis, in particular therapeutic plasma exchange, in neurological disorders that may frequently be seen by intensivists.

Key Words: therapeutic apheresis • therapeutic plasma exchange • acute Guillain-Barré syndrome • myasthenia gravis • multiple sclerosis • acute disseminated encephalomyelitis • Miller Fisher syndrome • Bickerstaff’s brain stem encephalitis

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Journal of Intensive Care Medicine, Vol. 20, No. 4, 212-225 (2005)
DOI: 10.1177/0885066605276816
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