Multiple Sclerosis (MS) is a chronic condition affecting the brain and spinal cord. This condition disrupts the flow of information within the brain and between the brain and the body. While there is no cure for MS, various treatments aim to manage symptoms and slow disease progression. Plasma exchange is a treatment option considered for specific situations in MS.
Understanding Plasma Exchange
Plasma is the liquid portion of your blood, consisting primarily of water, salts, and proteins. Plasma exchange, also known as plasmapheresis, is a medical procedure to “clean” the blood by removing and replacing a patient’s plasma. The process functions somewhat like kidney dialysis, where blood is drawn from the body and processed by a specialized machine.
During this procedure, the machine separates the plasma from the blood cells. The separated plasma, containing harmful antibodies or inflammatory mediators believed to contribute to MS attacks, is then discarded. The remaining blood cells are mixed with a replacement fluid, such as albumin or fresh frozen plasma, before being returned. This exchange aims to reduce the levels of these problematic substances in the bloodstream, alleviating symptoms during an MS relapse.
When Plasma Exchange is Recommended for MS
Plasma exchange is considered a second-line therapy for MS, used when severe relapses do not respond adequately to high-dose corticosteroid treatment. It is an acute intervention intended to address sudden, severe attacks, rather than a long-term therapy for disease progression. The American Academy of Neurology (AAN) recommends its use for individuals experiencing significant disability due to a relapse.
This treatment is considered for severe relapses in relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS). It is not considered an effective treatment for progressive forms of MS, like primary or secondary progressive MS, as studies have not shown it to help with the ongoing worsening of symptoms. Plasma exchange may also be an option for patients who cannot tolerate or have medical contraindications to high-dose corticosteroids.
What to Expect During and After Treatment
Before the plasma exchange procedure, patients are advised to drink 6-8 glasses of non-caffeinated fluids daily for up to three days to help prevent side effects. The procedure itself is performed in a hospital setting, though outpatient treatment is sometimes possible. A nurse or specialist will insert an intravenous (IV) needle into a vein, usually in each arm, though a central line in the shoulder or groin may be used if arm veins are too small.
Blood is drawn through one IV line and enters an apheresis machine, which separates the plasma from the blood cells. The process takes two to four hours per session, depending on the patient’s body size and the volume of plasma to be exchanged. Patients undergo a series of sessions, often three to seven treatments over one to two weeks. During the procedure, some patients may experience sensations such as coldness, lightheadedness, nausea, or tingling. After the session, it is common to feel tired for the day, but most individuals can resume their regular activities.
Outcomes and Potential Risks
While not universally effective, many patients undergoing plasma exchange for MS relapses experience a reduction in the severity of their symptoms or a faster recovery. One study reported that 78.7% of patients showed clinical improvement after therapeutic plasma exchange. Improvement is more likely if treatment begins within 20 days of symptom onset.
Plasma exchange can have side effects. During the procedure, patients may experience low blood pressure, leading to dizziness, weakness, or nausea. Other common sensations include fatigue, tingling, chills, or muscle cramps. More serious risks include infection due to temporary suppression of the immune system or catheter complications. Bleeding issues, allergic reactions to the replacement fluid, and electrolyte imbalances are also possible.