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Arch Neurol. 2011 Jul;68(7):870-8. doi: 10.1001/archneurol.2011.34. Epub 2011 Mar 14.

Beneficial plasma exchange response in central nervous system inflammatory demyelination.

Author information

1
Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

Abstract

BACKGROUND:

Plasma exchange (PLEX) is a beneficial rescue therapy for acute, steroid-refractory central nervous system inflammatory demyelinating disease (CNS-IDD). Despite the approximately 45% PLEX response rate reported among patients with CNS-IDD, determinants of interindividual differences in PLEX response are not well characterized.

OBJECTIVE:

To perform an exploratory analysis of clinical, radiographic, and serological features associated with beneficial PLEX response.

DESIGN:

Historical cohort study.

SETTING:

Neurology practice, Mayo Clinic College of Medicine, Rochester, Minnesota. Patients All Mayo Clinic patients treated with PLEX between January 5, 1999, and November 12, 2007, for a steroid-refractory CNS-IDD attack.

MAIN OUTCOME MEASURE:

The PLEX response in attack-related, targeted neurological deficit(s) assessed within the 6-month period following PLEX.

RESULTS:

We identified 153 patients treated with PLEX for a steroid-refractory CNS-IDD, of whom 90 (59%) exhibited moderate to marked functional neurological improvement within 6 months following treatment. Pre-PLEX clinical features associated with a beneficial PLEX response were shorter disease duration (P = .02) and preserved deep tendon reflexes (P = .001); post-PLEX variables included a diagnosis of relapsing-remitting multiple sclerosis (P = .008) and a lower Expanded Disability Status Scale score (P < .001) at last follow-up. Plasma exchange was less effective for patients with multiple sclerosis who subsequently developed a progressive disease course (P = .046). Radiographic features associated with a beneficial PLEX response were presence of ring-enhancing lesions (odds ratio = 4.00; P = .03) and/or mass effect (odds ratio = 3.00; P = .02). No association was found between neuromyelitis optica-IgG serostatus and PLEX response.

CONCLUSIONS:

We have identified clinical and radiographic features that may aid in identifying patients with fulminant, steroid-refractory CNS-IDD attacks who are more likely to respond to PLEX.

PMID:
21403003
PMCID:
PMC3134547
DOI:
10.1001/archneurol.2011.34
[Indexed for MEDLINE]
Free PMC Article

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