Plasmapheresis in the University of Malaya Medical Centre, Malaysia

Over the past 3 decades, plasmapheresis has been used more extensively for a variety of neurological and hematological disorders. We undertook a retrospective review to ascertain its safety, efficacy, and factor(s) that predispose to poor outcome. We reviewed 117 plasma exchanges in 24 patients with a mean age of 43 +/- 15 years; half were male. A total of 79% of the patients had neurological diseases, and the most common were chronic inflammatory demyelinating polyneuropathy, Guillain-Barré syndrome, and myasthenic crisis. Plasmapheresis was effective in 79% of the patients, especially for neurological indications. Complications occurred in 23% of the exchanges affecting 58% of the patients. Most complications were mild; sepsis was the most common (9.4% of exchanges), especially catheter related sepsis (6%), rash (4.3%), and hypotension (4.3%). Only 2 (8%) patients had severe complications that required mechanical ventilation. There were 5 mortalities (21%), 3 due to sepsis and 2 due to myocardial ischemia and arrhythmia, none of which occurred within 48 h of the last exchange. Patients with poor renal function had higher mortality. Overall, our figures agree with those from other institutions and indicate that plasma exchange is an effective and safe procedure, especially for a variety of neuroimmunological conditions.

Effects of Guillain-Barré sera containing antibodies against glycolipids in cultures of rat Schwann cells and sensory neurons

Serum samples from 52 patients with the acute Guillain-Barré syndrome (GBS), 19 patients with other neurological disorders, and 18 healthy volunteers were tested for cytotoxicity in cultures of rat Schwann cells and dorsal root ganglion neurons. The samples were also examined by enzyme-linked immunosorbent assay for IgG and IgM antibodies against various acidic and neutral glycolipids. Samples from 16 of the 52 (31%) acute GBS patients and from 1 of the 6 patients with chronic inflammatory demyelinating polyneuropathy produced myelin breakdown in culture. Although 10 of the 16 cytotoxic acute GBS serum samples contained anti-glycolipid immunoglobulins, there was no correlation in individual samples between cytotoxic activity and the presence of antibodies against specific glycolipids. While our results do not exclude a role for anti-glycolipid antibodies in the pathogenesis of the acute GBS, the cytotoxic effects of acute GBS serum in cultures of Schwann cells and sensory neurons are probably not due to these antibodies alone.

Ultrastructural effects of Guillain-Barré serum in cultures containing only rat Schwann cells and dorsal root ganglion neurons

Serum from patients with the acute form of the Guillain-Barré syndrome was applied to cultures containing only rat dorsal root ganglion neurons and Schwann cells. Serum taken from 4 of 10 patients during the first 1-3 weeks of clinical onset had previously been shown to have significant demyelinating activity in this culture system when observed at the light microscopic level. More detailed assessment made at the ultrastructural level showed that: (1) wide-spread myelin-related Schwann cell lysis occurred in concert with vesicular myelin breakdown; (2) non-myelin-related Schwann cells avidly phagocytized necrotic cell debris and fragments of compact myelin; and (3) neurites and non-myelin-related Schwann cells remained structurally undamaged. Cultures treated with convalescent phase serum from patients whose acute phase serum had cytolytic activity displayed no significant ultrastructural damage to either neurites or Schwann cells. This is the first electron microscopic study to provide direct evidence that acute Guillain-Barré serum can be cytolytic for myelin-related Schwann cells and peripheral myelin in an experimental setting free of leukocytes, lymphocytes and mononuclear phagocytes.

Serum antibodies to central nervous system antigens: an analysis of their relation with different human neurologic disorders

In a previous paper we have presented a double ligand enzyme linked immunosorbent assay (ELISA) technique suitable for the detection of human antibodies to different brain antigens. In the present study, we have applied this technique to the analysis of 100 neurologically affected patients with regard to both a list of clinical parameters and the presence in their sera of nervous tissue specific antibodies, in an attempt to highlight the meaning of such antibodies in different neurologic disorder. We show that the presence of these antibodies cannot be used for elucidation of pathogenesis or for diagnostic purposes, but can be used as a prognostic index.