Beneficial plasma exchange response in central nervous system inflammatory demyelination

Setty M. Magaña, B. Mark Keegan, Brian G. Weinshenker, Bradley J. Erickson, Sean J. Pittock, Vanda A. Lennon, Moses Rodriguez, Kristine Thomsen, Stephen Weigand, Jay Mandrekar, Linda Linbo, Claudia F. Lucchinetti

Research output: Contribution to journalArticlepeer-review

122 Scopus citations

Abstract

Background: Plasma exchange (PLEX) is a beneficial rescue therapy for acute, steroid-refractory central nervous system inflammatory demyelinating disease (CNSIDD). 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: Weidentified 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.

Original languageEnglish (US)
Pages (from-to)870-878
Number of pages9
JournalArchives of neurology
Volume68
Issue number7
DOIs
StatePublished - Jul 2011

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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