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Immunmodulatorische Therapie und Plasmaaustausch

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Zusammenfassung

Neuroimmunologische Erkrankungen wie die Myasthenia gravis oder das akute Guillain-Barré-Syndrom können sich rasch verschlechtern und damit die Behandlung auf der Intensivstation erforderlich machen. Neben symptomatischen Maßnahmen, wie der Überwachung der Atemfunktion und ggf. Einleitung und Durchführung der mechanischen Beatmung, kommt einer am Schweregrad der Erkrankung orientierten adäquaten Immuntherapie eine entscheidende Rolle zu, da sie den Krankheitsverlauf günstig beeinfl ussen und damit die Notwendigkeit der Intensivbehandlung abkürzen kann. Für die Belange der Intensivmedizin kommen Glucocorticosteroide (GS), üblicherweise hoch dosiert und intravenös gegeben, intravenöse Immunglobuline (IVIG) und die Plasmaaustauschbehandlung zum Einsatz. Im Folgenden werden die Prinzipien dieser Therapien besprochen.

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Literatur

  1. Barth J, Möllmann HW, Wagner T, Hochhaus G, Derendorf H. Problematik des Äquivalenzbegriffes bei der Therapie mit Glucocorticoiden. Ein Vergleich der klinischen Pharmakokinetik und Pharmakodynamik von Prednisolon und Methylprednisolon. Dtsch Med Wochenschr 1994; 119:1671–1676

    Article  PubMed  CAS  Google Scholar 

  2. Benny WB, Sutton DM, Oger J, Bril V, McAteer MJ, Rock G. Clinical evaluation of a staphylococcal protein A immunoabsorption system in the treatment of myasthenia gravis patients. Transfusion 1999; 39:682–687

    Article  PubMed  CAS  Google Scholar 

  3. Brecher ME. PlasmaExchange: Why We Do What We Do. J Clin Apheresis 2002; 17:207–211

    Article  PubMed  Google Scholar 

  4. Bril V, Ilse WK, Pearce R. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barré-Syndrome. Neurology 1996; 46:100–103

    PubMed  CAS  Google Scholar 

  5. Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Intravenous immunoglobulins neutralize blocking antibodies in Guillain- Barré syndrome. Ann Neurol 2002; 51:673–680

    Article  PubMed  CAS  Google Scholar 

  6. Buttgereit F, Wehling M, Burmester GR. A new hypothesis of modular glucocorticoid actions. Steroid treatment of rheumatic diseases revisited. Arthritis Rheumatism 1998; 41:761–767

    Article  PubMed  CAS  Google Scholar 

  7. Buttgereit F, Burmester GR, Brand MD. Bioenergetics of immune functions: fundamental and therapeutic aspects. Immunol Today 2000; 21:192–199

    Article  PubMed  CAS  Google Scholar 

  8. Dalakas MC. Controlled studies with high-dose intravenous immunoglobulin in the treatment of dermatomyositis, inclusion body myositis, and polymyositis. Neurology 1998; 51:S37-S45

    PubMed  CAS  Google Scholar 

  9. Dau PC. Plasmapheresis therapy in myasthenia gravis. Muscle and Nerve 1980; 3:468–482

    Article  PubMed  CAS  Google Scholar 

  10. Fateh-Moghadam A, Wick M, Besinger U, Geursen RG. High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 1984; 1:848–849

    Article  PubMed  CAS  Google Scholar 

  11. Flachenecker P, Mansouri Taleghani B, Gold R, Grossmann R, Wiebecke D, Toyka KV. Treatment of severe myasthenia gravis with protein A immunoadsorption and cyclophospamide. Transfus Sci 1998; 19 (Suppl):43–46

    PubMed  Google Scholar 

  12. Flachenecker P, Toyka KV, Gold R. Glukokortikoid-Therapie neurologischer Autoimmunerkrankungen. Münch Med Wschr 1999; 141:230–234

    Google Scholar 

  13. Gold R, Stangel M, Dalakas MC. Drug insight: the use of intravenous immunoglobulin in neurology - therapeutic considerations and practical issues. Nature Clin Practice Neurology 2007; 3:36–44

    Article  CAS  Google Scholar 

  14. Goss GA, Weinstein R. Pentastarch as Partial Replacement Fluid for Therapeutic Plasma Exchange: Effect on Plasma Proteins, Adverse Events During Treatment and Serum Ionized Calcium. J Clin Apheresis 1999; 14:114–121

    Article  PubMed  CAS  Google Scholar 

  15. Goulding NJ, Guyre PM. Glucocorticoids, lipocortins and the immune response. Curr Opin Immunol 1993; 5:108–113

    Article  PubMed  CAS  Google Scholar 

  16. Hatz HJ, editor. Glucocorticocoide. Immunologische Grundlagen, Pharmakologie und Therapierichtlinien. Wissenschaftliche Verlagsgesellschaft, Stuttgart 1998

    Google Scholar 

  17. Hohlfeld R, Toyka KV. Therapies. In: de Baets MH, Oosterhuis HJGH, editors. Myasthenia gravis. CRC Press, Boca Raton 1993, S 235–261

    Google Scholar 

  18. Jacobs BC, O’Hanlon GM, Bullens RW, et al. Immunoglobulins inhibit pathophysiological effects of anti-GQ1b-positive sera at motor nerve terminals through inhibition of antibody binding. Brain 2003; 126:2220–2234

    Article  PubMed  Google Scholar 

  19. Kaiser H, Kley HH. Kortisontherapie. Thieme, Stuttgart 1992

    Google Scholar 

  20. Keegan M, König F, McClelland R, et al. Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet 2005; 366:579–582

    Article  PubMed  Google Scholar 

  21. Korach JM, Berger P, Giraud C, Le Perff-Desman C, Chillet P. Role of replacement fluids in the immediate complications of plasma exchange. Intensive Care Med 1998; 24:452–458

    Article  PubMed  CAS  Google Scholar 

  22. Kuitwaard K, de Gelder J, Tio-Gillen AP, et al. Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome. Ann Neurol 2009; 66:597–603

    Article  PubMed  CAS  Google Scholar 

  23. Le Conte P, Nikolas F, Adjou C, N’Guyen JM, Billaud E, Moreau P. Replacement fluids in plasmapheresis : cross over comparitiv study. Intensive Care Med 1997; 23:342–344

    Article  PubMed  CAS  Google Scholar 

  24. Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. Deutscher Ärzteverlag 2001

    Google Scholar 

  25. McLeod BC. Introduction to the Third Special Issue: Clinical Application of Therapeutic Apheresis. J Clin Apheresis 2000, 15:1–5

    Article  PubMed  CAS  Google Scholar 

  26. Multiple Sklerose Therapie Konsensus Gruppe. Immunmodulatorische Stufentherapie der Multiplen Sklerose. Neue Aspekte und praktische Umsetzung. Nervenarzt 2002; 73: 556–563

    Article  Google Scholar 

  27. Olivares-Villagómez D, Wensky AK, Wang YJ, Lafaille JJ. Repertoire requirements of CD4+ T cells that prevent spontaneous autoimmune encephalomyelitis. J Immunol 2000; 164:5499–5507

    PubMed  Google Scholar 

  28. Owen HG, Brecher ME. Atypical reactions associated with the use of angiotensin-convertin enzyme inhibitors amd apheresis. Transfusion 1994; 34:891–894

    Article  PubMed  CAS  Google Scholar 

  29. Owen HG, Brecher ME. Partial Colloid Starch Replacement for Therapeutic Plasma Exchange. J Clin Apheresis 1997; 12:87–92

    Article  PubMed  CAS  Google Scholar 

  30. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Lancet 1997; 349:225–230

    Article  Google Scholar 

  31. Richtlinien zur Gewinnung vonBlut und Blutbestandteilen und zur Anwendung vonBlutprodukten (Hämotherapie), Fassung 2000. Deutscher Ärzte-Verlag

    Google Scholar 

  32. Rock G, Sutton DMC, Freedman J, Nair RC and Members of the Canadian Apheresis Group. Pentastarch Instead of Albumin as Replacement Fluid for therapeutic Plasma Exchange. J Clin Apheresis 1997, 12:165–169

    Article  PubMed  CAS  Google Scholar 

  33. Ruprecht K, Klinker E, Dintelmann T, Rieckmann P, Gold R. Plasma exchange for severe optic neuritis: treatment of 10 patients. Neurology 2004; 63:1081–1083

    PubMed  CAS  Google Scholar 

  34. Schilling S, Linker RA, König FB, Koziolek M, Bähr M, Müller GA, Paulus W, Gärtner J, Brück W, Chan A, Gold R. Plasmaaustausch bei steroidresistenten Multiple-Sklerose-Schüben. Klinische Erfahrungen an 16 Patienten. Nervenarzt 2006; 77:430–438

    Article  PubMed  CAS  Google Scholar 

  35. Schmidt J, Gold R, Schönrock L, Zettl UK, Hartung HP, Toyka KV. T-cell apoptosis in situ in experimental autoimmune encephalomyelitis following methylprednisolone pulse therapy. Brain 2000; 123:1431–1441

    Article  PubMed  Google Scholar 

  36. Schneider C, Matsumoto Y, Kohyama K, Toyka KV, Hartung HP, Gold R. Experimental autoimmune myositis in the lewis rat: lack of spontaneous T-cell apoptosis and therapeutic response to glucocorticosteroid application. J Neuroimmunol 2000; 107:83–87

    Article  PubMed  CAS  Google Scholar 

  37. Schröder A, Meyer C, Chan A, Gold R. PE in der Eskalationstherapie der MS. Langzeitbeobachtung an 54 Patienten. Nervenarzt 2010; 81 (Suppl 1):32

    Article  Google Scholar 

  38. Schwid SR, Goodman AD, Puzas JE, McDermott MP, Mattson DH. Sporadic corticosteroid pulses and osteoporosis in multiple sclerosis. Arch Neurol 1996; 53:753–757

    Article  PubMed  CAS  Google Scholar 

  39. Stangel M, Gold R. [Use of i.v. immunoglobulins in neurology: evidence-based consensus]. Nervenarzt 2004; 75:801–815

    Article  PubMed  CAS  Google Scholar 

  40. Toyka KV, Augspach R, Wietholter H, et al. Plasma exchange in chronic inflammatory polyneuropathy: evidence suggestive of a pathogenic humoral factor. Muscle Nerve 1982; 5:479–484

    Article  PubMed  CAS  Google Scholar 

  41. Toyka KV. Neurologische Indikation zur Plasmapherese. Akt Neurol 1984; 11:114–117

    Article  Google Scholar 

  42. Weber U, Riegel W, Köhler H. Therapeutischer Plasmaaustausch 1996. Medizinische Klinik 1997; 92:615–620

    Article  PubMed  CAS  Google Scholar 

  43. Van Koningsveld R, Schmitz PIM, Van Der Meché FGA, Visser LH, Meulstee J, van Doorn PA, for the Dutch GBS study group. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet 2004; 363:192–196

    Article  PubMed  Google Scholar 

  44. Vincent A, Bowen J, Newsom-Davis J, et al. Seronegative generalised myasthenia gravis: clinical features, antibodies and their targets. Lancet Neurol 2003; 2:99–106

    Article  PubMed  Google Scholar 

  45. Yu ZY, Lennon VA. Mechanism of intravenous immune globulin therapy in antibody-mediated autoimmune diseases. N Engl J Med 1999; 340:227–228

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Neurologisches Rehabilitationszentrum Quellenhof, Kuranlagenallee 2, 75323, Bad Wildbad

    PD Dr. P. Flachenecker

  2. Abteilung für Transfusionsmedizin, Uniklinikum Würzburg, Josef Schneider Str. 2, 97080, Würzburg

    Dr. E. Klinker

  3. Neurologische Klinik, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum

    Prof. Dr. R. Gold

Authors
  1. PD Dr. P. Flachenecker
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  2. Dr. E. Klinker
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  3. Prof. Dr. R. Gold
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Editor information

Editors and Affiliations

  1. Neurologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen

    Stefan Schwab

  2. Benediktuskrankenhaus, Neurologische Klinik und Geriatrie Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden

    Peter Schellinger

  3. Klinik für Anästhesiologie, Klinikum der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz

    Christian Werner

  4. Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg

    Andreas Unterberg  & Werner Hacke  & 

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Flachenecker, P., Klinker, E., Gold, R. (2012). Immunmodulatorische Therapie und Plasmaaustausch. In: Schwab, S., Schellinger, P., Werner, C., Unterberg, A., Hacke, W. (eds) NeuroIntensiv. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16911-3_19

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  • DOI: https://doi.org/10.1007/978-3-642-16911-3_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-16910-6

  • Online ISBN: 978-3-642-16911-3

  • eBook Packages: Medicine (German Language)

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