Highlights
- •Multiple sclerosis is the most common CNS inflammatory demyelinating disease.
- •Plasma exchange (PLEX) has well-demonstrated efficacy in demyelinating attacks.
- •Factors predictive of favorable PLEX outcome are elusive.
- •Apparent diffusion coefficient (ADC) on brain MRI does not predict PLEX response.
Abstract
Background
MS is the most common CNS inflammatory demyelinating disease. Plasma exchange (PLEX)
has well-demonstrated efficacy in acute corticosteroid-refractory attacks of demyelination
but identifying the factors that predict favorable PLEX response remains elusive.
We aimed to determine if apparent diffusion coefficient (ADC) restriction on brain
MRI predicts clinical response to PLEX in individuals with an acute cerebral attack
of MS.
Methods
Retrospective chart review of individuals with a cerebral attack of MS who underwent
PLEX at Mayo Clinic.
Results
We identified 34 individuals who fulfilled the inclusion criteria. Twenty-seven (79%)
responded to plasma exchange, with 16/34 (47%) having moderate and 11/34 (32%) marked
improvement. Twenty-three (68%) people had ADC restriction on brain MRI prior to PLEX.
ADC restriction did not predict response (p = 0.51). Several other pre-PLEX factors, including sex, Expanded Disability Status
Scale (EDSS) at initial attack, time to PLEX, and concurrent spinal cord attack, also
failed to predict response. Plasma-exchange responders had less disability at 6-month
follow-up compared to non-responders (median EDSS 2.5 (range 1.0–10.0) vs. 7.5 (5.5–10.0),
p<0.001).
Conclusion
Acute cerebral attacks of MS have a high rate of plasma exchange response resulting
in a lower EDSS at 6-months. ADC restriction does not predict response to plasma exchange.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Double-blind study of true vs. sham plasma exchange in patients treated with immunosuppression for acute attacks of multiple sclerosis.Neurology. 1989; 39 (Sep): 1143-1149https://doi.org/10.1212/wnl.39.9.1143
- Plasmapheresis in acute episodes of fulminant CNS inflammatory demyelination.Neurology. 1993; 43 (Jun): 1100-1104https://doi.org/10.1212/wnl.43.6.1100
- A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease.Ann. Neurol. 1999; 46 (Dec): 878-886https://doi.org/10.1002/1531-8249(199912)46:6<878::aid-ana10>3.0.co;2-q
- Plasma exchange or immunoadsorption in demyelinating diseases: a meta-analysis.J. Clin. Med. 2020; (May 25,): 9https://doi.org/10.3390/jcm9051597
- Beneficial plasma exchange response in central nervous system inflammatory demyelination.Arch. Neurol. 2011; 68 (Jul): 870-878https://doi.org/10.1001/archneurol.2011.34
- A retrospective cohort study of plasma exchange in central nervous system demyelinating events in children.Mult. Scler. Relat. Disord. 2019; 35 (Oct): 50-54https://doi.org/10.1016/j.msard.2019.07.004
- Plasma exchange for acute attacks of CNS demyelination: predictors of improvement at 6 months.Neurology. 2009; 73 (Sep 22): 949-953https://doi.org/10.1212/WNL.0b013e3181b879be
- Response to therapeutic plasma exchange as a rescue treatment in clinically isolated syndromes and acute worsening of multiple sclerosis: a retrospective analysis of 90 patients.PLOS One. 2015; 10e0134583https://doi.org/10.1371/journal.pone.0134583
- Differences in the reponses to apheresis therapy of patients with 3 histopathologically classified immunopathological patterns of multiple sclerosis.JAMA Neurol. 2018; 75 (Apr 1): 428-435https://doi.org/10.1001/jamaneurol.2017.4842
- Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange.Lancet. 2005; 366 (Aug 13-19): 579-582https://doi.org/10.1016/s0140-6736(05)67102-4
- Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions.Neurology. 2012; 78 (May 22): 1655-1662https://doi.org/10.1212/WNL.0b013e3182574f66
- Diffusion of water in large demyelinating lesions: a follow-up study.Neuroradiology. 2002; 44 (Sep): 764-767https://doi.org/10.1007/s00234-002-0806-y
- Diffusion-weighted echo-planar MR imaging: clinical applications and pitfalls – a pictorial essay.Clin. Imaging. 2000; 24 (Jul-Aug): 181-192https://doi.org/10.1016/s0899-7071(00)00203-5
- Increased water self-diffusion in chronic plaques and in apparently normal white matter in patients with multiple sclerosis.Acta Neurol. Scand. 1993; 87 (Mar): 195-199https://doi.org/10.1111/j.1600-0404.1993.tb04100.x
- Investigation of apparent diffusion coefficient and diffusion tensor anisotrophy in acute and chronic multiple sclerosis lesions.AJNR Am. J. Neuroradiol. 1999; 20 (Sep): 1491-1499
- Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018; 17 (Feb): 162-173https://doi.org/10.1016/S1474-4422(17)30470-2
- Rating neurologic impairment in multiple sclerosis.Neurology. 1983; 33: 1444
- A short test of mental status: description and preliminary results.Mayo Clin. Proc. 1987; 62 (Apr): 281-288https://doi.org/10.1016/s0025-6196(12)61905-3
- Plasma exchange for severe attacks of CNS demyelination: predictors of response.Neurology. 2002; 58 (Jan 8): 143-146https://doi.org/10.1212/wnl.58.1.143
- Plasma exchange in severe acute relapses of multiple sclerosis - results from a Portuguese cohort.Mult. Scler. Relat. Disord. 2018; 19 (Jan): 148-152https://doi.org/10.1016/j.msard.2017.12.001
- Plasma exchange for steroid-refractory relapses in multiple sclerosis: an observational, MRI pilot study.Clin. Ther. 2013; 35 (Apr): 474-485https://doi.org/10.1016/j.clinthera.2013.02.027
- Treatment of steroid-unresponsive tumefactive demyelinating disease with plasma exchange.Neurology. 2003; 61 (Oct 14author reply 1022): 1022https://doi.org/10.1212/01.wnl.0000082170.18782.97
Article info
Publication history
Published online: March 28, 2023
Accepted:
March 26,
2023
Received in revised form:
February 24,
2023
Received:
November 28,
2022
Identification
Copyright
© 2023 Published by Elsevier B.V.
