Abstract | OBJECTIVE: METHODS: Retrospective study in 27 episodes of severe acute attacks myelitis and optic neuritis in 24 patients, including 20 patients with NMOSD seropositive, 1 patient with NMOSD seronegative and 3 patients with LETM. Plasma exchange was performed, reflecting poor responses to high-dose intravenous methylprednisolone (IVMP) therapy. The outcomes of the present study were the functional outcome improvements at 6 months after plasma exchange. The predictive factors of good outcomes after plasma exchange were determined in this cohort, and additional factors reported in the literature were reviewed. RESULTS:
Plasma exchange was performed in 16 spinal cord attacks and 11 attacks of optic neuritis. Twenty patients were female (83%). The median age of the patients at the time of plasma exchange was 41 years old. The median disease duration was 0.6 years. The AQP4-IgG status was positive in 20 patients (83%). Plasma exchange following IVMP therapy led to a significant improvement in 81% of the cases after 6 months of follow up. A baseline Expanded Disability Status Scale (EDSS) score ≤6 before the attack was associated with significant improvement at 6 months (p=0.02, OR 58.33, 95%CI 1.92-1770). In addition, we reviewed the evidence for factors associated with good outcomes of plasma exchange in CNS IDDs, classified according to pre- plasma exchange, post- plasma exchange, and radiological features. CONCLUSION:
Plasma exchange following IVMP therapy is effective as a treatment for patients experiencing a severe attack of NMOSD or LETM. The factors associated with good outcomes after plasma exchange in CNS IDDs are reviewed in the literature. We classified 3 different aspects, including pre- plasma exchange factors, based on minimal disability at baseline, preserved reflexes, early initiation, and short disease duration; post plasma exchange factors, including early improvement or lower disability at last follow up; and radiographic factors, for which the presence of active gadolinium lesions and the absence of spinal cord atrophy seem to be good outcomes for plasmapheresis.
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Authors | Saharat Aungsumart, Metha Apiwattanakul |
Journal | Multiple sclerosis and related disorders
(Mult Scler Relat Disord)
Vol. 13
Pg. 93-97
(Apr 2017)
ISSN: 2211-0356 [Electronic] Netherlands |
PMID | 28427710
(Publication Type: Journal Article)
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Copyright | Copyright © 2017. Published by Elsevier B.V. |
Chemical References |
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Topics |
- Adult
- Aquaporin 4
(immunology)
- Female
- Humans
- Male
- Middle Aged
- Myelitis, Transverse
(immunology, therapy)
- Neuromyelitis Optica
(immunology, therapy)
- Plasma Exchange
- Retrospective Studies
- Treatment Outcome
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