{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:20:39Z","timestamp":1793578839142,"version":"4.5.0"},"reference-count":52,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Plasma exchange (PLEX) is a therapeutic apheresis modality in which the plasma is separated from inflammatory factors such as circulating autoreactive immunoglobulins, the complement system, and cytokines, and its therapeutic effect is based on the removal of these mediators of pathological processes. Plasma exchange is well established for various neurological disorders, and it is applied successfully in central nervous system inflammatory demyelinating diseases (CNS-IDD). It mainly modulates the humoral immune system; thus, it has a greater theoretical effect in diseases with prominent humoral mechanisms, such as neuromyelitis optica (NMO). However, it also has a proven therapeutic effect in multiple sclerosis (MS) attacks. Several studies have suggested that patients with severe attacks of CNS-IDD have poor response to steroid therapy but show clinical improvement after the PLEX treatment. Currently, PLEX is generally established only as a rescue therapy for steroid unresponsive relapses. However, there are still research gaps in the literature regarding plasma volume, number of sessions, and how early the apheresis treatment needs to started. Thus, in the present article, we summarize the clinical studies and meta-analyses, especially about MS and NMO, outlining clinical data regarding the experience with therapeutic PLEX in severe attacks of CNS-IDD, the clinical improvement rates, the prognostic factors of a favorable response, and highlighting the likely role of the early apheresis treatment. Further, we have gathered this evidence and suggested a protocol for the treatment of CNS-IDD with PLEX in the routine clinical practice.<\/jats:p>","DOI":"10.1055\/s-0042-1758447","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T23:57:07Z","timestamp":1681516627000},"page":"296-307","source":"Crossref","is-referenced-by-count":13,"title":["Plasma exchange in inflammatory demyelinating disorders of the central nervous system: reasonable use in the clinical practice"],"prefix":"10.1055","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-2655","authenticated-orcid":false,"given":"Andr\u00e9 Luiz Guimar\u00e3es de","family":"Queiroz","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, Servi\u00e7o de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1694-0457","authenticated-orcid":false,"given":"Herval Ribeiro","family":"Soares Neto","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, Servi\u00e7o de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7785-9516","authenticated-orcid":false,"given":"Thiago Taya","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, Servi\u00e7o de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9937-2175","authenticated-orcid":false,"given":"Sonia Maria Cesar de Azevedo","family":"Silva","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, Servi\u00e7o de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,4,14]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/jca.10041","article-title":"Plasma exchange: why we do what we do","volume":"17","author":"M E Brecher","year":"2002","journal-title":"J Clin Apher"},{"issue":"03","key":"ref2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1111\/j.1759-1961.2010.00010.x","article-title":"Plasmapheresis for neuroinflammatory disorders","volume":"1","author":"A Schr\u00f6der","year":"2010","journal-title":"Clin Exp Neuroimmunol"},{"issue":"12","key":"ref3","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1212\/WNL.0b013e3181b879be","article-title":"Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months","volume":"73","author":"S Llufriu","year":"2009","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"787630","DOI":"10.1155\/2012\/787630","article-title":"Plasma exchange in severe attacks of neuromyelitis optica","volume":"2012","author":"M Bonnan","year":"2012","journal-title":"Mult Scler Int"},{"issue":"04","key":"ref5","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1177\/1352458508100837","article-title":"Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder","volume":"15","author":"M Bonnan","year":"2009","journal-title":"Mult Scler"},{"issue":"07","key":"ref6","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1001\/archneurol.2011.34","article-title":"Beneficial plasma exchange response in central nervous system inflammatory demyelination","volume":"68","author":"S M Maga\u00f1a","year":"2011","journal-title":"Arch Neurol"},{"issue":"01","key":"ref7","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1002\/jca.1010","article-title":"Plasma exchange for severe attacks of inflammatory demyelinating diseases of the central nervous system","volume":"16","author":"B G Weinshenker","year":"2001","journal-title":"J Clin Apher"},{"issue":"03","key":"ref8","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/S1471-4914(00)01909-2","article-title":"Heterogeneity of multiple sclerosis pathogenesis: implications for diagnosis and therapy","volume":"7","author":"H Lassmann","year":"2001","journal-title":"Trends Mol Med"},{"issue":"01","key":"ref9","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s13311-012-0160-7","article-title":"Treatment of acute relapses in multiple sclerosis","volume":"10","author":"R Berkovich","year":"2013","journal-title":"Neurotherapeutics"},{"issue":"04","key":"ref10","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.nurt.2007.07.008","article-title":"Corticosteroids for multiple sclerosis: I. 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