Favorable effects of plasma exchange in managing neurological conditions

Abstract

Plasma exchange is a well-established therapeutic procedure used in various autoimmune neurological disorders. The clinical utility of plasma exchange is evolving and outcomes vary from partial to complete improvement in clinical condition with or without support of immunosuppressant medications. We are reporting beneficial effects of plasma exchange in two cases as unusual indication. 52 years old male, presented with 1 week history of confusion, unsteadiness, dysarthria, progressive to quadriplegia and respiratory failure need ICU admission and intubation. Extensive workup reveal Seronegative Autoimmune Encephalitis associated with predominant cortical, limbic and cerebellar involvement in MRI brain. He was given trial of IV immunoglobulin (IVIG) for 5 days followed by prednisolone 60mg daily, with improvement in respiratory status only. Six sessions alternate day of plasma exchange were done, with marked improvement in clinical condition. He was maintained on azathioprine 100mg. 22 years old lady, had morbid obesity underwent laparoscopic sleeve gastrectomy. After one week she developed vomiting and bilateral limb weakness. She was diagnosed with Guillain-Barré syndrome (GBS) and received IVIG for 5 days. She developed acute respiratory failure, intubation and tracheostomy for long term ventilation. She was on regular physical therapy without improvement. After one month, she had trial of plasma exchange even though she failed IVIG and she is Category III grade 2C by ASFA guidelines. She had 6 sessions of alternate days plasma exchanges with clinical improvement in power. Plasma exchange is good immunomodulation therapy for Autoimmune Limbic Encephalitis and severe GBS who failed IVIG.