title: Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange.
abstract: 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.
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Keegan
authors.forename: Fatima
authors.initials: F
authors.lastname: König
authors.forename: Robyn
authors.initials: R
authors.lastname: McClelland
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brück
authors.forename: Yazmín
authors.initials: Y
authors.lastname: Morales
authors.forename: Andreas
authors.initials: A
authors.lastname: Bitsch
authors.forename: Hillel
authors.initials: H
authors.lastname: Panitch
authors.forename: Hans
authors.initials: H
authors.lastname: Lassmann
authors.forename: Brian
authors.initials: B
authors.lastname: Weinshenker
authors.forename: Moses
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Joseph
authors.initials: J
authors.lastname: Parisi
authors.forename: Claudia F
authors.initials: CF
authors.lastname: Lucchinetti
mesh_terms: 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