Plasmapheresis as a treatment for multiple sclerosis (MS) has been a subject of controversy since its original use in this disorder in 1979 11-31. The rationale for the use of plasmapheresis is that MS presumably is an autoimmune disease with evidence for the presence of anti-myelin antibodies 14-61, non-antibody demyelinating factors [7], and neuroelectric blocking agents in the serum 181. Therefore, it has been argued that removal of these harmful substances may halt or retard the process of injury to the myelin sheath. The encouragement generated by the successful treatment of myasthenia gravis [9] and Guillain-Barre syndrome [lo] added to the hope that this age-old concept but new technology could be a useful modality in treating patients with MS.
Reviewing the literature on the use of plasmapheresis in acute attacks of MS reveals several uncontrolled reports of success in treatment of MS [1,3,11] and one controlled clinical trial with modest benefit at 1 month but no long-term effect [12]. In this study, Weiner et al. performed a double-blind trial of true versus sham plasma exchange in patients treated with immunosuppression for acute attacks of MS. This was a 5-center cooperative study of plasmapheresis administered to patients in the midst of an acute exacerbation of MS. One hundred sixteen patients were treated in a randomized, double-blind trial of an 8-week course of 11 plasma exchange treatments in exacerbations of MS. Fifty-nine patients received true and 57 received sham pheresis. Twenty patients in each group were in chronic progressive phase and the rest were remittinghelapsing. Both groups received identical treatment with IM ACTH and oral cyclophosphamide. All patients had modest but statistically significant enhanced improvement at 2 weeks relative to the sham group. In the relapsingh-emitting group, patients receiving plasmapheresis had enhanced improvement on Kurtzke Disability Status Scale (DSS) at 4 weeks. Improvement was defined as a reduction of 1 grade in those patients entering the study with a grade of 6B or higher and a reduction of 2 grades for those entering with a DSS of 6A or less. Life table analysis showed a shorter time to reach the pre-attack disability