Effect of immunotherapy in myelitis with atopic diathesis.

Abstract

OBJECTIVE:

A recent nationwide survey of myelitis with atopic diathesis in Japan disclosed that the disease frequently shows a chronic persistent course. A neuropathological study of the spinal cord also revealed chronic active inflammation. Since the effects of various immunotherapies have not been studied extensively in this condition, we evaluated the efficacies of various immunotherapies in patients with myelitis with atopic diathesis.

PATIENTS AND METHODS:

Forty-two treatments in 26 patients with myelitis with atopic diathesis were retrospectively analyzed. One of the following therapies was administered: (1) corticosteroids (CS) (pulse therapy followed by oral administration with gradual tapering); (2) intravenous immunoglobulin (IVIG) (400 mg/kg/day for 5 consecutive days); (3) plasma exchanges (PE); or (4) PE followed by IVIG or CS (PE+IVIG/CS). The therapeutic efficacies were evaluated by thorough neurological examination and laboratory tests including MRI, somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs).

RESULTS:

Objective neurological findings improved in 89% of the PE group and 90% of the PE+IVIG/CS group, compared with only 72% of the CS and 60% of the IVIG groups. Improvement determined by laboratory tests was seen in 57% of the PE and 57% of the PE+IVIG/CS groups, compared with only 15% of the CS and none of the IVIG groups. Thus, the improvement rate determined by laboratory tests was significantly greater for therapies including PE than for those without PE (p=0.0187).

CONCLUSIONS:

These data suggest that immunotherapy is effective in myelitis with atopic diathesis despite a chronic persistent course, and that PE is the most beneficial immunotherapy.

• Authors: Hiroyuki Murai, Hajime Arahata, Manabu Osoegawa, Hirofumi Ochi, Motozumi Minohara, Takayuki Taniwaki, Shozo Tobimatsu, Futoshi Mihara, Yuko Tsuruta, Shoichi Inaba, Jun-Ichi Kira
• Journal: Journal of the neurological sciences (J Neurol Sci) Vol. 227 Issue 1 Pg. 39-47 (Dec 15 2004) ISSN: 0022-510X [Print] Netherlands
• PMID: 15546590 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Immunoglobulins, Intravenous

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Chi-Square Distribution
• Combined Modality Therapy
• Dermatitis, Atopic (blood, physiopathology, therapy)
• Eosinophils (drug effects)
• Evoked Potentials, Motor (drug effects)
• Evoked Potentials, Somatosensory (drug effects)
• Female
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunotherapy
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Myelitis (blood, physiopathology, therapy)
• Neurologic Examination (methods)
• Plasma Exchange (methods)
• Retrospective Studies
• Spinal Cord (drug effects, pathology)
• Treatment Outcome
• Upper Extremity (physiopathology)