Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange.
Early, active multiple sclerosis lesions show four immunopathological patterns of demyelination. Although these patterns differ between patients, multiple active lesions from a given patient have an identical pattern, which suggests pathogenic heterogeneity. Therapeutic plasma exchange (TPE) has been successfully used to treat fulminant demyelinating attacks unresponsive to steroids. We postulated that patients with pattern II would be more likely to improve after TPE than those with other patterns since pattern II lesions are distinguished by prominent immunoglobulin deposition and complement activation. We retrospectively studied 19 patients treated with TPE for an attack of fulminant CNS inflammatory demyelinating disease. All patients with pattern II (n=10), but none with pattern I (n=3) or pattern III (n=6), achieved moderate to substantial functional neurological improvement after TPE (p<0.0001). Patients with multiple sclerosis with pattern II pathology are more likely to respond favourably to TPE than are patients with patterns I or III.
Keegan
Mark
M
Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
König
Fatima
F
McClelland
Robyn
R
Brück
Wolfgang
W
Morales
Yazmín
Y
Bitsch
Andreas
A
Panitch
Hillel
H
Lassmann
Hans
H
Weinshenker
Brian
B
Rodriguez
Moses
M
Parisi
Joseph
J
Lucchinetti
Claudia F
CF
D000203:Activities of Daily Living; D000328:Adult; D001921:Brain / Q000473:pathology; D006801:Humans; D009103:Multiple Sclerosis / Q000097:blood / Q000473:pathology / Q000628:therapy*; D010951:Plasma Exchange