Beneficial plasma exchange response in central nervous system inflammatory demyelination

Arch Neurol. 2011 Jul;68(7):870-8. doi: 10.1001/archneurol.2011.34. Epub 2011 Mar 14.


Background: 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.

Objective: To perform an exploratory analysis of clinical, radiographic, and serological features associated with beneficial PLEX response.

Design: Historical cohort study.

Setting: 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.

Main outcome measure: The PLEX response in attack-related, targeted neurological deficit(s) assessed within the 6-month period following PLEX.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain / diagnostic imaging
  • Brain / pathology
  • Central Nervous System Diseases / complications
  • Central Nervous System Diseases / diagnostic imaging
  • Central Nervous System Diseases / therapy*
  • Child
  • Cohort Studies
  • Confidence Intervals
  • Demyelinating Diseases / complications
  • Demyelinating Diseases / diagnostic imaging
  • Demyelinating Diseases / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Odds Ratio
  • Plasma Exchange / methods*
  • Radiography
  • Spinal Cord / diagnostic imaging
  • Spinal Cord / pathology
  • Young Adult