7.26 p.m. ET (2326 GMT) October 3, 1999 by Tony Cappasso
For most people with multiple sclerosis, symptoms flare up, then fade away. The disease worsens slowly and gradually. It's a common form of the illness called relapsing remitting MS.
But for some MS patients, the first signs of the illness build rapidly until they end up crippled or paralyzed in a short period of time. When MS takes this form, it can leave sufferers disabled, even paralyzed, in a very short period, explains Dr. Brian Weinshenker, an MS specialist at the Mayo Clinic in Rochester, Minn.
Weinshenker and his colleagues have developed a treatment called plasma exchange to aid people with this sort of MS.
Forty-two percent of patients in a new study who had plasma exchange got moderate to marked symptom relief, including full recovery of the use of their arms and legs and their ability to talk, according to Weinshenker, who headed the study. In the majority of the patients who improved, the benefit lasted up to three years following treatment, he says.
Weinshenker's research will be published in this December's issue of Annals of Neurology.
In plasma exchange, a patient's blood is removed and the blood cells are mechanically separated from the plasma, the fluid portion of the blood. The patient's blood cells then get mixed with fresh plasma and the mixture is returned to the patient.
Some of the stories of recovery were truly remarkable. One 19-year-old woman didn't even know she had MS until she began to have vision problems and trouble walking. She was finally diagnosed with the illness and within a week was confined to a wheelchair, explains Allison Mitchell, National Multiple Sclerosis Society spokeswoman.
Another patient complained to his doctor of numbness in one leg. A few days later his legs were virtually paralyzed from MS, said Mitchell. Both these patients underwent plasma exchange and had dramatic reversals of their symptoms, she said.
Weinshenker says the research shows clearly that the treatment works for some patients, but he's not sure why. One theory is that plasma contains immune factors such as antibodies that may be responsible for MS's attack on the nervous system, he says. Replacing natural plasma with a synthetic kind may dilute the antibodies, lessening the attack and helping patients to regain function, he says.
However, Weinshenker emphasizes that plasma exchange treatment is not a cure and it isn't for every MS patient.
"Plasma exchange should be considered only for those patients who have severe, acute attacks of MS that are not responsive to high-dose steroid treatments," he says. "It should not be considered as initial treatment for attacks of MS."
The Mayo Clinic study included 22 people who experienced acute, severe attacks of MS and related diseases. During the randomized, double blind study, patients underwent either plasma exchange or a placebo treatment every two days for a total of seven treatments.
In the placebo method, blood was similarly separated into the blood cells and plasma and then recombined and returned to the patient unchanged. After the seven treatments, those patients who did not show improvement were exchanged and received the other MS treatment, according to Weinshenker. That way, all the patients in the study had the opportunity to receive therapy.
In all, about 40 percent of the 19 patients who had the active treatment
had moderate to marked improvement in their nerve function. Four individuals
who were considered treatment successes and five who did not improve with
treatment experienced recurrent attacks during six months of follow-up.