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In patients with refractory conditions, standard immunosuppression is often insufficient for complete recovery or to prevent relapses. These patients rely on other treatments to manage their disease. While treatment of refractory cases differs between diseases, intravenous immunoglobulin, plasma exchange (PLEX), and immune-modulating treatments are commonly used. In this review, we focus on five autoimmune neurological disorders that were the themes of the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology: Autoimmune Encephalitis (AE), Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum disorders (NMOSD), Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Myasthenia Gravis (MG).\u00a0The diagnosis of inflammatory neuropathies is often challenging, and while PLEX can be very effective in refractory autoimmune diseases, its ineffectiveness can be confounded by misdiagnosis. One example is POEMS syndrome (characterized by\n                    <jats:underline>P<\/jats:underline>\n                    olyneuropathy\n                    <jats:underline>O<\/jats:underline>\n                    rganomegaly,\n                    <jats:underline>E<\/jats:underline>\n                    ndocrinopathy,\n                    <jats:underline>M<\/jats:underline>\n                    yeloma protein,\n                    <jats:underline>S<\/jats:underline>\n                    kin changes), which is often wrongly diagnosed as CIDP; and while CIDP responds well to PLEX, POEMS does not. Accurate diagnosis is therefore essential. Success rates can also differ within \u2018one\u2019 disease: e.g. response rates to PLEX are considerably higher in refractory relapsing remitting MS compared to primary or secondary progressive MS. When sufficient efforts are made to correctly pinpoint the diagnosis along with the type and subtype of refractory autoimmune disease, PLEX and other immunotherapies can play a valuable role in the patient management.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s11481-021-10004-9","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T10:35:39Z","timestamp":1633343739000},"page":"806-817","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["The Role of Plasma Exchange in the Treatment of Refractory Autoimmune Neurological Diseases: a Narrative Review"],"prefix":"10.1007","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-454X","authenticated-orcid":false,"given":"Saiju","family":"Jacob","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Mazibrada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarosh R","family":"Irani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Yudina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,2]]},"reference":[{"key":"10004_CR1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1177\/1352458515581438","volume":"22","author":"H Abboud","year":"2016","unstructured":"Abboud H, Petrak A, Mealy M, Sasidharan S, Siddique L, Levy M (2016) Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange. 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Saiju Jacob reports advisory board remunerations from Alexion Pharmaceuticals, Alnylam Pharmaceuticals and ArgenX Ltds, and speaker\/chairman fees from Eisai Ltd, UCB Pharma and Terumo BCT. This includes speaker fees received for the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology, which is the basis of this article. Gordon Mazibrada reports advisory board consultancy honoraria, international meeting sponsorship and MS research and service development donations from Biogen, Genzyme, Novartis, Merck-Serono, Roche and Teva. This includes speaker fees received for the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology, which is the basis of this article. Sarosh Irani reports grants, personal fees and non-financial support from UCB, personal fees from Roivant, personal fees and non-financial support from MedImmun, during the conduct of the study; personal fees from ADCT, grants from ONO, grants from CSL Behring, outside the submitted work; In addition, Sarosh Irani has a patent VGKC \/ LGI1\/ CASPR2 antibodies with royalties. Anu Jacob reports honoraria and speaker fees from Terumo BCT for talks related to plasma exchange. Anu Jacob is lead for the UK NHS NMO service (2010-2020).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest\/Competing Interests"}}]}}