Background: There are limited number of studies investigating efficacy and safety of plasma exchange (PLEX) in treating acute demyelinating diseases like Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO). In a randomised double-blind trial of PLEX in treating acute demyelinating attacks,42% of patients on active treatment had significant improvement compared to 5.9% on sham. Aims: To retrospectively investigate immediate and short-term efficacy of PLEX treatment of acute inflammatory relapses. Methods: Retrospective chart review of patients treated with PLEX between 2001 and 2009 for CNS demyelination. Minimum possible EDSS for relapse severity and Maximum possible EDSS for steroids and PLEX treatment effect was determined. Clinical impression of treatment efficacy (CITE) was used to rate outcome of treatment with steroids and PLEX. CITE 0=no improvement, 1=mild improvement(no effect on function), 2=moderate improvement(effect on function), 3=marked improvement. Results: 42 patients and 52 relapses (mean age 44.01 yrs STD 9.44 min 22yrs and max 60yrs; 19 asian, 28 caucasian and 4 others, 37 female 15 male; 20 MS, 29 NMO, and 3 ADEM) were reviewed by two neurology MS fellows familiar with EDSS and CITE. Relapses were moderate (15) to severe (37). Mean EDSS during attacks was 7.25 (SD 1.53). 78% of 45 relapses treated with high dose steroid pulse prior to PLEX did not report improvement (Mean CITE 0.42 SD 0.59). All relapses were eventually treated with PLEX. 44% had moderate to marked improvement, 38% had mild recovery and 11% had no improvement (Mean CITE 1.55 SD 0.95). Mean EDSS after treatment was 6.37 (SD 1.69). Relapses with optic, sensory and cerebellar components seemed to respond better than motor and bulbar relapses. Patients with NMO (CITE 1.74 SD 0.93) had more favourable outcome than patients with MS (CITE 1.37 SD 0.93). 52% of NMO relapses had moderate to marked improvement, and 7% had no improvement. 35 % of MS relapses had moderate to marked improvement, 15 % had no improvement. 35 % of patients started treatment within first month of relapse and had better response to PLEX (CITE 1.68 SD 0.98) than others (CITE 1.47 SD 0.92) Conclusion: Results support previous reports on the benifit of PLEX. NMO, patients with optic, sensory and cerebellar relapses, and early treatment (<4weeks) were all in favour of better outcome from PLEX. MS patients appeared to benefit from PLEX and should be considered in the acute management of severe demyelinating syndromes.
Read More: Plasma exchange in treatment of acute inflammatory demyelinating diseases