51. Beneficial plasma exchange response in central nervous system inflammatory demyelination
- Author
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Vanda A. Lennon, Linda Linbo, Kristine M. Thomsen, Sean J. Pittock, B. Mark Keegan, Stephen D. Weigand, Setty M. Magaña, Brian G. Weinshenker, Moses Rodriguez, Bradley J. Erickson, Jay Mandrekar, and Claudia F. Lucchinetti
- Subjects
Adult ,Male ,medicine.medical_specialty ,animal structures ,Neurology ,Adolescent ,Fulminant ,Article ,Cohort Studies ,Young Adult ,Arts and Humanities (miscellaneous) ,Central Nervous System Diseases ,Internal medicine ,medicine ,Confidence Intervals ,Odds Ratio ,Humans ,Young adult ,Child ,Aged ,Neuromyelitis optica ,Expanded Disability Status Scale ,Plasma Exchange ,business.industry ,Multiple sclerosis ,fungi ,Brain ,Odds ratio ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Radiography ,Logistic Models ,Spinal Cord ,Female ,Neurology (clinical) ,business ,Cohort study ,Demyelinating Diseases ,Follow-Up Studies - Abstract
Plasma exchange (PLEX) is a beneficial rescue therapy for acute, steroid-refractory central nervous system inflammatory demyelinating disease (CNS-IDD). Despite the approximately 45% PLEX response rate reported among patients with CNS-IDD, determinants of interindividual differences in PLEX response are not well characterized.To perform an exploratory analysis of clinical, radiographic, and serological features associated with beneficial PLEX response.Historical cohort study.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.The PLEX response in attack-related, targeted neurological deficit(s) assessed within the 6-month period following PLEX.We identified 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.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.
- Published
- 2011