[Plasmapheresis in central nervous system disorders].

Therapeutic plasmapheresis (TPE) has an established role in disorders of the peripheral nervous system, but its use in disorders of the central nervous system (CNS) does not rely upon evidence-based data. Nevertheless, TPE is currently used in severe acute forms of demyelinating disease (multiple sclerosis/acute encephalomyelitis) unresponsive to corticosteroids. Recently, antibodies against the water channel aquaporin-4 have been detected in patients affected by neuromyelitis optica (Devic syndrome) and their pathogenetic role has been demonstrated, supporting the use of TPE in this disease. TPE has been reported to be effective in some patients affected by stiff-person syndrome or limbic encephalitis associated with antibodies against voltagegated potassium channels. TPE has also been used in selected patients with treatment-resistant epilepsy or status epilepticus within complex syndromes of various etiologies. The available data still do not support the use of TPE in most paraneoplastic disorders of the CNS.