The number of apheresis procedures to treat immune-mediated neurological diseases is on the rise.

Apheresis is used for the treatment of many different diseases, especially when conventional therapy lacks efficacy. There are however some diseases in which apheresis is accepted as first line therapy. The aim of this analysis was to investigate the use of apheresis for the treatment of neurological diseases and the changes over two decades in the World Apheresis Association registry. During the period 2003-2023, a total of 23,699 apheresis procedures in 2963 patients with a neurological disease were performed. Data were collected during different periods by 44 centers, out of which 22 centers had been registering continuously over the latest 10 years. An increase in the proportion of neurological diseases developed over the period (p < 0.001) while the overall apheresis procedures remained stable (p = 0.46). Most procedures were due to myasthenia gravis (MG; n = 11,049 (31 % of patients), Guillain-Barré Syndrome (GBS; n = 3247 (30 %), multiple sclerosis (MS; n = 2665 (18 %)), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP; n = 2367 (3 %)), and neuromyelitis optica (NMO; n = 650 (2 %)). A change in the proportion of these diseases was noted over time. Adverse events (AEs) differed significantly between the diseases. Patients with GBS had most moderate and severe AEs. Hypotension was the most common severe AE. The panorama of different neurological diseases may cause different AEs based on the variation in neurological response to the apheresis procedure and replacement fluid. It is important to expand this knowledge among those who are prescribing and those performing the apheresis procedures.