Effect of immunotherapy in myelitis with atopic diathesis.
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.
Murai
Hiroyuki
H
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Arahata
Hajime
H
Osoegawa
Manabu
M
Ochi
Hirofumi
H
Minohara
Motozumi
M
Taniwaki
Takayuki
T
Tobimatsu
Shozo
S
Mihara
Futoshi
F
Tsuruta
Yuko
Y
Inaba
Shoichi
S
Kira
Jun-Ichi
J
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
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous