title: Effect of immunotherapy in myelitis with atopic diathesis.
abstract: OBJECTIVE
  A recent nationwide survey of myelitis with atopic diathesis in Japan disclosed that the disease frequently shows a chronic persistent course. A neuropathological study of the spinal cord also revealed chronic active inflammation. Since the effects of various immunotherapies have not been studied extensively in this condition, we evaluated the efficacies of various immunotherapies in patients with myelitis with atopic diathesis.
  
  
  METHODS
  Forty-two treatments in 26 patients with myelitis with atopic diathesis were retrospectively analyzed. One of the following therapies was administered: (1) corticosteroids (CS) (pulse therapy followed by oral administration with gradual tapering); (2) intravenous immunoglobulin (IVIG) (400 mg/kg/day for 5 consecutive days); (3) plasma exchanges (PE); or (4) PE followed by IVIG or CS (PE+IVIG/CS). The therapeutic efficacies were evaluated by thorough neurological examination and laboratory tests including MRI, somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs).
  
  
  RESULTS
  Objective neurological findings improved in 89% of the PE group and 90% of the PE+IVIG/CS group, compared with only 72% of the CS and 60% of the IVIG groups. Improvement determined by laboratory tests was seen in 57% of the PE and 57% of the PE+IVIG/CS groups, compared with only 15% of the CS and none of the IVIG groups. Thus, the improvement rate determined by laboratory tests was significantly greater for therapies including PE than for those without PE (p=0.0187).
  
  
  CONCLUSIONS
  These data suggest that immunotherapy is effective in myelitis with atopic diathesis despite a chronic persistent course, and that PE is the most beneficial immunotherapy.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Murai
authors.forename: Hajime
authors.initials: H
authors.lastname: Arahata
authors.forename: Manabu
authors.initials: M
authors.lastname: Osoegawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ochi
authors.forename: Motozumi
authors.initials: M
authors.lastname: Minohara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Taniwaki
authors.forename: Shozo
authors.initials: S
authors.lastname: Tobimatsu
authors.forename: Futoshi
authors.initials: F
authors.lastname: Mihara
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tsuruta
authors.forename: Shoichi
authors.initials: S
authors.lastname: Inaba
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kira
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D004804:Eosinophils / Q000187:drug effects; D019054:Evoked Potentials, Motor / Q000187:drug effects; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007167:Immunotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D009460:Neurologic Examination / Q000379:methods; D010951:Plasma Exchange / Q000379:methods; D012189:Retrospective Studies; D013116:Spinal Cord / Q000187:drug effects / Q000473:pathology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous