title: Therapeutic plasma exchange in glucocorticosteroid-unresponsive patients with Clinically Isolated Syndrome.
abstract: Clinically Isolated Syndromes (CIS) summarize clinical features of possible multiple sclerosis (MS) as a first clinical event of the disease. Escalation therapy in CIS episodes comprises high dose glucocorticosteroid (GCS) treatment followed by therapeutic plasma exchange (TPE) in patients unresponsive to GCS. The aim of our study was to analyze TPE effects in CIS patients. Eleven GCS-unresponsive patients exhibiting CIS were treated with TPE. A median of 5.0 (range 3-8) treatments were performed with a median exchange volume of 3.0 L (range 2.2-3.5 L). Standard diagnostic results in CIS patients were collected. In 10 out of 11 patients clinical improvement was observed. In Expanded Disability Status Scale (EDSS) Scoring, a commonly used score to assess disability in MS and CIS patients, significant improvement was shown as well. One patient was a non-responder to TPE. Apheresis treatments were well tolerated in all patients. In the medical control of GCS-unresponsive CIS episodes, TPE appears to be an effective and well-tolerated treatment option. TPE response in CIS patients is comparable to TPE results in GCS-unresponsive MS relapses. Further prospective studies are indicated.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany; Department of Neurology, University of Rostock, Rostock, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ehler
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koball
authors.forename: Martin
authors.initials: M
authors.lastname: Sauer
authors.forename: Heiko
authors.initials: H
authors.lastname: Hickstein
authors.forename: Steffen
authors.initials: S
authors.lastname: Mitzner
authors.forename: Reiner
authors.initials: R
authors.lastname: Benecke
authors.forename: Uwe K
authors.initials: UK
authors.lastname: Zettl
mesh_terms: D000328:Adult; D001781:Blood Component Removal / Q000379:methods; D003711:Demyelinating Diseases / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids
keywords: Apheresis; Escalation therapy; Multiple sclerosis; Neuroimmunology; Steroid-refractory