First Experience and the Effectiveness of Immunomodulating Treatment in Inflammatory Demyelinating CNS Diseases: Analysis of Nine Patients / Imūnmodulējošās Terapijas Efektivitāte Centrālās Nervu Sistēmas Iekaisīgu Saslimšanu Gadījumos: Deviņu Pacientu Analīze
Therapeutic plasma exchange (TPE) is used in many neurological disorders to remove immunoglobulin and other immunologically active substances. We observed patients that were admitted in Rīga East Clinical University Hospital “Gaiļezers”, Clinic of Neurology and Neurosurgery, Multiple Sclerosis Unit, and were diagnosed with relapsing remitting multiple sclerosis (MS), according to McDonald criteria 2010 (five patients), Neuromyelitis optica (NMO) spectrum disorders (three patients) and one with NMO, according to Wingerchuk 2006 criteria. All relapses were confirmed according to clinical criteria. Visual acuity was assessed by an ophthalmologist, and neurological status by a neurologist. All patients received at least 1 cycle of 1000 mg methylprednisolone intravenous for five to seven days. The expanded disability status scale score in the MS patient group was in range 4.0-9.0 before TPE and 3.5-6.5 range after TPE. Best improvement was observed in the MS group: mean symptom reduction of 20%. Patients with NMO spectrum disorder had an EDSS score of 8.0-8.5 range on admission and 6.5-8.0 range after TPE. After one month, one patient in the NMO spectrum disorder group had good response to TPE and EDSS was 3.5, two patients had only slight improvement (EDSS scores 8.0 and 7.5). Condition of patients with NMO did not improve even after a month.
If the inline PDF is not rendering correctly, you can download the PDF file here.
Cortese I. Chaudhry V. So Y. T. Cantor F. Cornblath D. R. Rae-Grant A. (2011). Evidence-based guideline update: plasmapheresis in neurologic disorders: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 76 (3) 294-300.
Hughes R. A. Swan A. V. Raphael J. C. Annane D. van Koningsveld R. van Doorn P. (2007). Immunotherapy for Guillain-Barre syndrome: A systematic review. Brain 130 (pt 9) 2245-2257.
Ibrahim R. B. Balogun R. A. (2012). Medications in patients treated with therapeutic plasma exchange: Prescription dosage timing and drug overdose.
Seminars in Dialysis 25 (2) 176-189.
Kaya E. Keklik M. Sencan M. Yilmaz M. Keskin A. Kiki I. Erkurt M. A. Sivgin S. Korkmaz S. Okan V. Došu M. H. Unal A. Cetin M. Altuntaº F. Ilhan O. (2013). Therapeutic plasma exchange in patients with neurological diseases: Multicenter retrospective analysis. Transfus.
Apher. Sci. 48 (3) 349-352.
Keegan M. Pineda A. A. McClelland R. L. Darby C. H. Rodriguez M. Weinshenker B. G. (2002). Plasma exchange for severe attacks of CNS demyelination: Predictors of response. Neurology 58 (1) 143-146.
Keller A. J. Urbaniak S. J. (1978). Intensive plasma exchange on the cell separator: Effects on serum immunoglobulins and complement components.
Brit. J. Haematol. 38 (4) 531-540.
Kes P. Basiã-Kes V. Basiã-Jukiã N. Demarin V. (2012). Therapeutic plasma exchange in the neurologic intensive care setting recommendation for clinical practice. Acta Clin. Croat. 51 (1) 137-153.
Lassmann H. Brück W. Lucchinetti C. F. (2007). The immunopathology of multiple sclerosis: An overview. Brain Pathol. 17 (2) 210-218.
Lennon V. A. Wingerchuk D. M. Kryzer T. J. Pittock S. J. Lucchinetti C. F. Fujihara K. Nakashima I. Weinshenker B. G. (2004). A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis. Lancet 364 (9451) 2106-2112.
Miyamoto K. Kusunoki S. (2009). Intermittent plasmapheresis prevents recurrence in neuromyelitis optica. Ther. Apher. Dial. 13 (6) 505-508.
Munemoto M. Otaki Y. Kasama S. Nanami M. Tokuyama M. Yahiro M. Hasuike Y. Kuragano T. Yoshikawa H. Nonoguchi H. Nakanishi T. (2011). Therapeutic efficacy of double filtration plasmapheresis in patients with anti-aquaporin-4 antibody-positive multiple sclerosis. J. Clin.
Neurosci. 18 (4) 478-480.
Polman C. Reingold S. Banwell B. Clanet M. Cohen J. A. Filippi M. Fujihara K. Havrdova E. Hutchinson M. Kappos L. Lublin F. D. Montalban X. O’Connor P. Sandberg-Wollheim M. Thompson A. J. Waubant E. Weinshenker B. Wolinsky S. (2011). Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann. Neurol. 69 (2) 292-302.
Ruprecht K. Klinker E. Dintelmann T. Rieckmann P. Gold R. (2004).
Plasma exchange for severe optic neuritis: Treatment of 10 patients. Neurology 63 (6) 1081-1083.
Sellner J. Boggild M. Clanet M. Hintzen R. Q. Illes Z. Montalban X. Du Pasquier R. A. Polman C. H. Sorensen P. S. Hemmer B. (2010).
EFNS guidelines on diagnosis and management of Neuromyelitis optica.
Eur. J. Neurol. 17 (8) 1019-1032.
Szczepiorkowski Z. M. Winters J. L. Bandarenko N. Kim H. C. Linenberger M. L. Marques M. B. Sarode R. Schwartz J. Weinstein R. Shaz B. H. (2010). Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J. Clin. Apher. 25 (3) 83-177.
Sellebjerg F. Barnes D. Filippini G. Midgard R. Montalban X. Rieckmann P. Selmaj K. Visser L. H. Soelberg S¸rensen P. (2011).
Acute relapses of multiple sclerosis. In: Gilhus N. E. Barnes M. P. Brainin M. (eds.). European Handbook of Neurological Management.
Vol. 1. 2nd edn. Blackwell Publishing Ltd. pp. 411-419.
Watanabe S. Nakashima I. Misu T. Miyazawa I. Shiga Y. Fujihara K. Itoyama Y. (2007). Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult. Scler. 13 (1) 128-132.
Weinshenker B. G. O'Brien P. C. Petterson T. M. Noseworthy J. H. Lucchinetti C. F. Dodick D. W. Pineda A. A. Stevens L. N. Rodriguez M. (1999). A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann. Neurol. 46 (6) 878-886.
Wingerchuk D. M. Lennon V. A. Pittock S. J. Lucchinetti C. F. Weinshenker B. G. (2006). Revised diagnostic criteria for neuromyelitis optica. Neurology 66 (10) 1485-1489.
Yilmaz A. A. Can O. S. Oral M. Unal N. Ayyildiz E. Ilhan O. Tulunay M. (2011). Therapeutic plasma exchange in an intensive care unit (ICU): A 10-year single-center experience. Transfus. Apher. Sci. 45 (2) 161-166.
Yoshida H. Ando A. Sho K. Akioka M. Kawai E. Arai E. Nishimura T. Shinde A. Masaki H. Takahashi K. Takagi M. Tanaka K. (2010).
Anti-aquaporin-4 antibody-positive optic neuritis treated with double-filtration plasmapheresis. J. Ocul. Pharmacol. Ther. 26 (4) 381-385.