Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months.
BACKGROUND
Plasma exchange (PE) is used to treat severe episodes of CNS demyelination unresponsive to corticosteroids. Predictors of long-term response are not well known.


METHODS
We retrospectively reviewed the medical records of 41 patients consecutively treated by PE between January 1995 and July 2007. The primary outcome was improvement at 6 months after PE defined as decrease of >or=1 point in the Expanded Disability Status Scale (EDSS) score for patients with EDSS <or=7.5 or 1.5 points with EDSS >or=8.0 or improvement of more than 2 lines in the visual acuity chart for patients with optic neuritis (ON).


RESULTS
Twenty-five patients (61%) were women, and the median age was 33 years (range 14-57 years). Twenty-three (56%) had multiple sclerosis, 2 (5%) had clinically isolated syndrome, 2 (5%) had Marburg disease, 7 (17%) had acute disseminated encephalomyelitis, 4 (10%) had neuromyelitis optica, 2 (5%) had idiopathic ON, and 1 (2%) had idiopathic transverse myelitis. The median EDSS score before the attack was 1.0 (range 0-6.5). At PE onset, the median EDSS score was 7.0 (range 3.0-9.5). Sixteen patients (39%) improved at discharge, and 26 (63%) improved at 6 months. In the multivariate analysis, early initiation of PE (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.18-52.96) and improvement at discharge (OR 7.32, 95% CI 1.21-44.38) were significantly associated with response at 6 months.


CONCLUSIONS
Plasma exchange (PE) was associated with clinical improvement in 63% of patients at 6 months. Early initiation of PE and improvement at discharge were predictors of this response. Twelve patients (48%) who did not improve early did so during follow-up.
Llufriu
S
S
Neurology Service, Hospital Clinic, Universitat de Barcelona and Institut d'Investigació Biomèdica August Pi i Sunyer, 08036 Barcelona, Spain.
Castillo
J
J
Blanco
Y
Y
Ramió-Torrentà
L
L
Río
J
J
Vallès
M
M
Lozano
M
M
Castellà
M D
MD
Calabia
J
J
Horga
A
A
Graus
F
F
Montalban
X
X
Saiz
Albert
A
D000208:Acute Disease / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000818:Animals; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003711:Demyelinating Diseases / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008379:Marburg Virus Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D009188:Myelitis, Transverse / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D009471:Neuromyelitis Optica / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D010951:Plasma Exchange / Q000379:methods / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult