Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange

Mark Keegan, Fatima König, Robyn McClelland, Wolfgang Brück, Yazmín Morales, Andreas Bitsch, Hillel Panitch, Hans Lassmann, Brian Weinshenker, Moses Rodriguez, Joseph Parisi, Claudia F. Lucchinetti

Research output: Contribution to journalArticlepeer-review

332 Scopus citations

Abstract

Early, active multiple sclerosis lesions show four immunopathological patterns of demyelination. Although these patterns differ between patients, multiple active lesions from a given patient have an identical pattern, which suggests pathogenic heterogeneity. Therapeutic plasma exchange (TPE) has been successfully used to treat fulminant demyelinating attacks unresponsive to steroids. We postulated that patients with pattern II would be more likely to improve after TPE than those with other patterns since pattern II lesions are distinguished by prominent immunoglobulin deposition and complement activation. We retrospectively studied 19 patients treated with TPE for an attack of fulminant CNS inflammatory demyelinating disease. All patients with pattern II (n=10), but none with pattern I (n=3) or pattern III (n=6), achieved moderate to substantial functional neurological improvement after TPE (p<0·0001). Patients with multiple sclerosis with pattern II pathology are more likely to respond favourably to TPE than are patients with patterns I or III.

Original languageEnglish (US)
Pages (from-to)579-582
Number of pages4
JournalLancet
Volume366
Issue number9485
DOIs
StatePublished - Aug 13 2005

ASJC Scopus subject areas

  • Medicine(all)

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