Highlights
- •Plasma exchange is an effective rescue therapy in patients with severe acute attacks.
- •The factors associated with good outcomes are:
- •Pre-plasma exchange factors: minimal disability at baseline and early treatment.
- •Post plasma exchange factors: early improvement or lower disability at last follow up.
- •Radiographic factors: active gadolinium lesions and absence of spinal cord atrophy.
- •
Abstract
Objective
To investigate the predictive factors associated with good outcomes of plasma exchange
in severe attacks through neuromyelitis optica spectrum disorder (NMOSD) and long
extensive transverse myelitis (LETM). In addition, to review the literature of predictive
factors associated with the good outcomes of plasma exchange in central nervous system
inflammatory demyelinating diseases (CNS IDDs).
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.
Keywords
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Article info
Publication history
Published online: February 18, 2017
Accepted:
February 18,
2017
Received in revised form:
February 11,
2017
Received:
December 21,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
