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 Volume 73, Number 12, September 22, 2009
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NEUROLOGY 2009;73:949-953
© 2009 American Academy of Neurology

Plasma exchange for acute attacks of CNS demyelination

Predictors of improvement at 6 months S. Llufriu, MD, J. Castillo, MD, Y. Blanco, MD, L. Ramió-Torrentà, MD, J. Río, MD, M. Vallès, MD, M. Lozano, MD, M. D. Castellà, MD, J. Calabia, MD, A. Horga, MD, F. Graus, MD, X. Montalban, MD and A. Saiz, MD

From the Neurology (S.L., Y.B., F.G., A.S.) and Hemotherapy-Hemostasis (M.L.) Services, Hospital Clínic, Universitat de Barcelona and Institut d’Investigació Biomèdica August Pi i Sunyer; Centre d’Esclerosi Múltiple de Catalunya (J.C., J.R., A.H., X.M.), CEM-Cat, Unitat de Neuroimmunologia Clínica, and Centre de Transfusió i Banc de Teixits (M.D.C.), Hospital Universitari Vall d’Hebron, Barcelona; and Neurology (L.R.-T.) and Nephrology (M.V., J.C.) Services, Hospital Josep Trueta, Girona, Spain.

Address correspondence and reprint requests to Dr. Albert Saiz, Service of Neurology, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain asaiz{at}clinic.ub.es

Background: Plasma exchange (PE) is used to treat severe episodes of CNS demyelination unresponsive to corticosteroids. Predictors of long-term response are not well known.

Methods: We retrospectively reviewed the medical records of 41 patients consecutively treated by PE between January 1995 and July 2007. The primary outcome was improvement at 6 months after PE defined as decrease of ≥1 point in the Expanded Disability Status Scale (EDSS) score for patients with EDSS ≤7.5 or 1.5 points with EDSS ≥8.0 or improvement of more than 2 lines in the visual acuity chart for patients with optic neuritis (ON).

Results: Twenty-five patients (61%) were women, and the median age was 33 years (range 14–57 years). Twenty-three (56%) had multiple sclerosis, 2 (5%) had clinically isolated syndrome, 2 (5%) had Marburg disease, 7 (17%) had acute disseminated encephalomyelitis, 4 (10%) had neuromyelitis optica, 2 (5%) had idiopathic ON, and 1 (2%) had idiopathic transverse myelitis. The median EDSS score before the attack was 1.0 (range 0–6.5). At PE onset, the median EDSS score was 7.0 (range 3.0–9.5). Sixteen patients (39%) improved at discharge, and 26 (63%) improved at 6 months. In the multivariate analysis, early initiation of PE (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.18–52.96) and improvement at discharge (OR 7.32, 95% CI 1.21–44.38) were significantly associated with response at 6 months.

Conclusions: Plasma exchange (PE) was associated with clinical improvement in 63% of patients at 6 months. Early initiation of PE and improvement at discharge were predictors of this response. Twelve patients (48%) who did not improve early did so during follow-up.

Abbreviations: CI = confidence interval; CIS = clinically isolated demyelinating syndrome; EDSS = Expanded Disability Status Scale; MS = multiple sclerosis; NA = not applicable; NMO = neuromyelitis optica; non-MS = excludes multiple sclerosis and clinically isolated syndrome; ON = optic neuritis; OR = odds ratio; PE = plasma exchange; VA = visual acuity.

Supplemental data at www.neurology.org

*These authors had equal participation in the study.

Supported in part by grant PI060070, Fondo de Investigaciones Sanitarias, Madrid, Spain (A.S.), and Red Española de Esclerosis Múltiple (F.G., RD07/0060/0012; X.M., RD07/0060/0020; L.R.-T., RD07/0060/002), Instituto de Salud Carlos III, Madrid, Spain.

Disclosure: Author disclosures are provided at the end of the article.

Received April 7, 2009. Accepted in final form June 30, 2009.