Plasma Exchange

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Plasma Exchange

Postby thinkingoutloud86 » Thu Apr 30, 2009 5:04 pm

With the neurology conference, a lot has been coming out. Ran into this article on plasma exchange and had not heard much about it previously. Anyone else have any info on it?

TOL

<shortened url>

Research Shows Plasma Exchange Helps Multiple Sclerosis Patients

Aurora Health Care Logo(PRNewsFoto/Aurora Health Care)

MILWAUKEE, WI UNITED STATES




Aurora St. Luke's Team Sees Lives Changed for the Better

with Plasma Exchange.

MILWAUKEE, April 29 /PRNewswire/ -- Researchers at Aurora St. Luke's Medical Center in Milwaukee report that plasma exchange therapy or PLEX dramatically improves the health of multiple sclerosis patients who fail to respond to conventional therapies.

(Logo: http://www.newscom.com/cgi-bin/prnh/200 ... 8204LOGO-b)

"There is no other treatment that brings about such a reversal in multiple sclerosis," says Bhupendra Khatri, M.D., the study's principal investigator and director of Aurora's Regional Multiple Sclerosis Center. "This treatment can turn lives around."

Over 25 years, Dr. Khatri and his team followed 271 patients with chronic and progressive multiple sclerosis. These patients had not responded to drug therapy and were experiencing an increasing decline in their motor and verbal abilities. Patients received weekly plasma exchange treatments for 10 weeks, with the pace of plasma exchange therapy slowing over time or as their condition improved.

Out of 271 patients, 217 or 80 percent, saw a long-term improvement in their disability.

Unlike conventional multiple sclerosis treatments, such as chemotherapy drugs, which can have serious side effects such as heart damage or leukemia, the plasma exchange therapy was found to be safe, with no serious side effects.

The study, "Sustained Long-Term Improvement in Disability with Plasma Exchange in Patients with Worsening Multiple Sclerosis: Results of a 25-Year Study," was presented April 29 at the American Academy of Neurology annual meeting in Seattle.

Dr. Khatri explained that patients with chronic, progressive multiple sclerosis may see their condition stabilize with conventional therapies, but they generally do not see any improvement in their condition. This is what makes the plasma exchange therapy all the more remarkable, according to Dr. Khatri. Not only did the majority of patients with worsening symptoms respond to plasma exchange, over time many patients found their weak limbs became stronger, their steps steadier and their speech clearer. Some grew strong enough that they could return to work.

Plasma exchange is a process where the patient's blood is run through a centrifuge, which separates out the plasma. The plasma is replaced with a synthetic fluid, and the blood is returned to the patient. Plasma exchange is thought to work because it filters out the agents that attack the nervous system. Once the bloodstream is cleared, the body has the opportunity to repair itself.

Multiple sclerosis is a disease where the body's immune system attacks the protective sheath surrounding the nerves. The National Multiple Sclerosis Society estimates 400,000 people in the United States have the disease. There is no cure for multiple sclerosis though there are several drugs that can slow or stop its progress. Symptoms can include blurred vision, loss of coordination and short-term or long-term memory loss.

Multiple sclerosis has been linked to vitamin D deficiency, and its geographic distribution is tied to sunshine. One in 500 Wisconsin residents have multiple sclerosis, while one in 10,000 Texans have the disease.

Aurora Health Care is a not-for-profit health care provider and a national leader in efforts to improve the quality of health care. Aurora offers care at sites in more than 90 communities throughout eastern Wisconsin.
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Postby Lars » Thu Apr 30, 2009 6:01 pm

It is commonly used to treat Guillain- Bare syndrome. I think at about 5 or 6 grand a pop. I remember having a discussion at one point with Lyon about this. It seems to make sense.....Bob?
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Postby dignan » Fri May 01, 2009 9:40 pm

I thought it was interesting to see this again. They presented data about 18 months ago at ECTRIMS and I was impressed, but it didn't make much of an impression on the MS research world, I suppose because the study is single centre, observational with no placebo group. But still, the results sound impressive. Here is last year's abstract...

http://www.thisisms.com/ftopicp-31396.html
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Postby thinkingoutloud86 » Sat May 02, 2009 10:47 am

That's right. Now I remember. It is interesting in that it is being presented at respected neurology conferences with very impressive claims/results, where it has to pass a review process, yet there hasn't been a lot of follow up. The group at Mayo looked at it, but one would think that these kind of results would prompt more research into it by other centers.
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Postby cheerleader » Sat May 02, 2009 3:19 pm

thinkingoutloud86 wrote:That's right. Now I remember. It is interesting in that it is being presented at respected neurology conferences with very impressive claims/results, where it has to pass a review process, yet there hasn't been a lot of follow up. The group at Mayo looked at it, but one would think that these kind of results would prompt more research into it by other centers.


No $ to be made in plasma exchange. The Wisc. Aurora Health Care Group which sponsored that research is a non-for-profit. That's why there's not more being done. I believe plasma exchange increases oxygenation in blood and may (temporarily) overcome venous insufficiencies and slowed perfusion.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Lars » Sat May 02, 2009 4:40 pm

Cheer,
Great point about $'s. Sadly those of us on LDN are acutely aware of that point. Even sadder is that the cure may come but be ignored because no one gets rich.
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Postby dignan » Sat May 02, 2009 5:32 pm

Here is the AAN abstract:

Long Term Improvement in the Disability of Worsening MS Patients with Plasma Exchange: Results of a 25 Year Follow up Study

Bhupendra Khatri, Milwaukee, WI, Michael McQuillen, Palo Alto, CA, Sergey Tarima, Mary Dukic, John Kramer, Milwaukee, WI

OBJECTIVE: To determine the benefit of long-term plasma exchange for patients who have failed corticosteroid therapy.

BACKGROUND: Plasma exchange (PLEX) is an effective therapy for Multiple Sclerosis (MS) patients who continue to worsen despite corticosteroid therapy (CST). A double blind controlled study proved PLEX to be significantly effective in reversing disability in chronic progressive MS patients. This study reports long-term follow-up results in patients with worsening MS treated with PLEX over the past twenty-five years at our center.

DESIGN/METHODS: Worsening MS patients who failed CST were offered PLEX. Worsening on Extended Disability Status Scale (EDSS) by at least one step was required by the insurance carriers before authorization of PLEX. Authorized patients received weekly PLEX for ten weeks and then in declining frequency until clinical stabilization.

RESULTS: 271 patients received PE. Age range 19-70, median 41; duration of disease 1-36 years median 7; disease severity (EDSS) 3-9.5, median 6.5; 74% female; number of PE 3-227, median 20. Improvement in disability with PLEX occurred in 217 of the 271 patients (p <0.0001). This improvement was well sustained at 6-year follow-up (p<0.001) and stabilized during years seven to nine. From years ten to twenty-five, patients started to worsen on EDSS but at a much slower pace than prior to PLEX (0.07 EDSS decline per year post PE vs. 2.6 per year prior to PE). This difference was significant, p <0.001. Clinical predictors of better response to PLEX were greater magnitude of worsening two years prior to PE (p <0.001) and duration of disease less than 7.8 years (p <0.001).

CONCLUSIONS/RELEVANCE: PLEX can bring about significant and lasting improvement in the disability of worsening MS patients. PLEX is safe. The importance of our findings are highlighted by the large number and types of MS patients selected, the magnitude of improvement and most importantly, duration for which the improvement lasted.
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Hyperbaric oxygen

Postby lyndacarol » Sat May 02, 2009 7:03 pm

Just this week I heard a news report about a hyperbaric oxygen unit somewhere in Florida that had blown up. A couple people were hurt, but no one was killed. The report was early and there were no other details.

Everything in life is risky.
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Postby Lars » Sat May 02, 2009 7:18 pm

LCarol,
I'm not sure I understand the correlation to PLEX? I do however, suppose any high O2 atmosphere could be risky. By the way Dignan, I think I gave Bob credit for some information on a post I submitted about 10 spots down this list regarding Plex. I re-read, and as usual, on this (and many) threads it was you. Sorry and thanks.
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Misplaced post--sorry

Postby lyndacarol » Sun May 03, 2009 8:23 am

Lars -- I have made a mistake and posted this info about hyperbaric oxygen here, sorry. I had read someone's post about HBO and intended my comment to go there.

Simply deleting my comment may make more confusion to later readers so I hope this post will clear this up.
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Postby marcstck » Sun May 03, 2009 4:00 pm

I did five rounds of plasmapheresis back in 2007 in an attempt to control my PPMS. The treatment was grueling and entirely unpleasant, and did absolutely nothing beneficial for me. You can read about my experience with plasmapheresis in my blog, here's the link...

http://www.wheelchairkamikaze.com/2009/ ... three.html
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Postby Lars » Mon May 04, 2009 8:17 am

Marc,
Thanks. I have seen a few posts from people who have NOT had success with PLEX. It would be nice to find someone who has. For a simple mind (mine) the concept seems valid.
Peace,
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Postby Caralea » Thu Oct 22, 2009 11:06 am

I actually had very good results with PLEX last year. I had an exacerbation that was not responding to steroids at all and continuing to get worse- I posted the details of it on my introduction thread. (though I forgot to say the lesion was at C-2 and covered over 85% of my spine by the time it was done)

When I went into the hospital for this procedure i had immediate improvement in my ability to walk but took a turn for the worse when the nurses ignored my call for help and I ended up passed out on the bathroom floor with a big black eye and head lump. I continued with the treatment and within 4 days after that I was improving again and went home on the 8th day.

It took me a long time to recover from that episode but my neurologist believes that I would have quite likely ended up wheelchair bound or dead if we had not tried PLEX.

That's my experience with it!
:)
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