title: Plasma exchange for steroid-refractory relapses in multiple sclerosis: an observational, MRI pilot study.
abstract: BACKGROUND
  Numerous studies have shown that plasma exchange (PE) is effective as second-line treatment of severe exacerbations of multiple sclerosis (MS) or other idiopathic inflammatory demyelinating diseases of the central nervous system that are nonresponsive to steroid therapy.
  
  
  OBJECTIVE
  The goal of this study was to analyze the effect of PE on clinically active radiologic lesions in steroid-refractory relapses of MS and idiopathic inflammatory demyelinating diseases of the central nervous system.
  
  
  METHODS
  This was a prospective, observational pilot study in which the primary end point was the degree of radiologic resolution of active lesions after PE.
  
  
  RESULTS
  A total of 15 patients were included (median age, 36.9 years [age range, 21-67 years]; 60% women). Five (33.3%) of the 15 patients had relapsing-remitting MS, 2 (13.3%) had clinically isolated syndrome that presented with transverse myelitis, 2 (13.3%) had recurrent myelitis, 1 (6.7%) had transverse myelitis, 1 (6.7%) had longitudinally extensive transverse myelitis, 1 (6.7%) had acute disseminated encephalomyelitis, 1 (6.7%) had Baló's concentric sclerosis, and 2 (13.3%) had neuromyelitis optica. Mean increase on the expanded disability status scale scores due to relapses was 4.8 (2.53). After PE, 93.3% showed a marked to moderate clinical improvement, and 46.7% recovered their baseline expanded disability status scale score 3 months post-PE. On the post-PE MRI, 60% showed radiologic resolution (80% mass-effect lesions, 83.3% new-onset disease, and 100% neuromyelitis optica), 20% had partial resolution, and 20% no resolution. A significant relationship was not obtained between degree of resolution of radiologic lesions and the variables: clinical response to PE, new-onset disease, mass-effect lesions, number of PE sessions, and early initiation of PE.
  
  
  CONCLUSIONS
  A marked to moderate clinical improvement post-PE accompanied by a lack of radiologic resolution of the active lesion is not indicative of poor prognosis.
authors.affiliation: Department of Neurology, Multiple Sclerosis Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. pmecal@gmail.com
authors.forename: Jose E
authors.initials: JE
authors.lastname: Meca-Lallana
authors.forename: Rocío
authors.initials: R
authors.lastname: Hernández-Clares
authors.forename: Adelaida
authors.initials: A
authors.lastname: León-Hernández
authors.forename: Alicia
authors.initials: A
authors.lastname: Genovés Aleixandre
authors.forename: Margarita
authors.initials: M
authors.lastname: Cacho Pérez
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Martín-Fernández
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D010951:Plasma Exchange; D012008:Recurrence; D055815:Young Adult