title: Response to Therapeutic Plasma Exchange as a Rescue Treatment in Clinically Isolated Syndromes and Acute Worsening of Multiple Sclerosis: A Retrospective Analysis of 90 Patients.
abstract: OBJECTIVE
  Experience with therapeutic plasma exchange (TPE) for acute relapses in clinically isolated syndrome (CIS) or multiple sclerosis (MS) patients has been derived from small and inhomogeneous patient populations so far. In the present study, we retrospectively evaluated features associated with TPE response in a larger cohort of CIS and MS patients with acute worsening of disease.
  
  
  METHODS
  Ninety CIS and MS patients with acute relapses or acute worsening of symptoms were firstly treated with TPE. The population consisted of 62 women and 28 men with a median age of 38 years (range 18-69 years).
  
  
  METHODS
  Primary endpoint was the clinical response to TPE, focused on the functional improvement of the target neurologic deficit. Secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring.
  
  
  RESULTS
  A clinical response to TPE was observed in 65 out of 90 patients (72.2%), with marked improvement in 18 (20.0%) and moderate improvement in 47 out of 90 patients (52.2%). The median EDSS was reduced from 3.75 before to 3.0 after TPE (p = 0.001). Response to TPE was significantly more frequent in patients with relapsing courses of disease (CIS, RR-MS, p = 0.001), no disease modifying drugs (p = 0.017), gadolinium-positive (Gd+) MRI lesions (p = 0.001) and EDSS ≤ 5.0 before TPE (p = 0.014). In the multiple logistic regression analysis only the detection of Gd+ MRI lesions was significantly altered (p = 0.004).
  
  
  CONCLUSIONS
  Clinical response to TPE was achieved in the majority of our patients. We identified clinical and diagnostic features in CIS and MS relapses that might be helpful to identify patients responding to TPE. Gd+ MRI lesions before treatment were the best predictor of the response to TPE in our cohort.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany; Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ehler
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Rostock, Rostock, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koball
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sauer
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Rostock, Rostock, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Mitzner
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Rostock, Rostock, Germany; KfH Dialysis Centre Wismar, Wismar, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Hickstein
authors.affiliation: Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Benecke
authors.affiliation: Department of Neurology, Neuroimmunology Section, University of Rostock, Rostock, Germany.
authors.forename: Uwe K
authors.initials: UK
authors.lastname: Zettl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003711:Demyelinating Diseases / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology / Q000628:therapy*; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult