Plasma exchange for acute attacks of CNS demyelination

Llufriú, Sara; Castilló, Joaquim; Blanco, Yolanda; Ramió-Torrentà, Luís; J, Río; Vallès, Margarita; Lozano, Miguel; Castellà, M. Dolors; Calabia, Juan; Horga, Alejandro; Graus, Francesc; Montalbán, Xavier; Sáiz, Albert

doi:10.1212/wnl.0b013e3181b879be

Cited by 177 publications

(149 citation statements)

References 16 publications

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“…In three retrospective studies in a total of 87 patients with definitive diagnosis of MS and refractory relapses to high-dose steroids, it was reported that effective treatment was achieved with therapeutic plasma exchange in two-thirds of patients (79,80,81). The situation is different for acute isolated optic neuritis refractory to high-dose steroid and no benefit from therapeutic plasma exchange could be demonstrated.…”

Section: Plasmapheresismentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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Section: Plasmapheresismentioning

confidence: 99%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

tnd

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“…Неселективные методы экс-тракорпоральной гемокоррекции, как известно, на-шли широкое применение при рассеянном склерозе, а также других демиелинизирующих заболеваниях нервной системы. Эти методы достаточно давно при-меняются, обеспечивая более эффективное лечение [17,18], однако, в отличие от полуселективных ме-тодов, к которым относится каскадная плазмофиль-трация, имеют ряд недостатков. Так, плазмаферез за одну процедуру обеспечивает в среднем 20-30% замены объема циркулирующей плазмы, что тре-бует проведения не менее 3 процедур через 1-3 сут за 1 курс.…”

Section: российский вестник перинатологии и педиатрии 2 2016 Rossiyunclassified

Combination therapy for multiple sclerosis in children

Скрипченко¹,

Ivanova²,

Суровцева³

et al. 2016

Ross. vestn. perinatol. pediatr.

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“…Those patients who had not recovered early by PE (12 patients, 48%) did not get any better at follow-up. 74 A further retrospective review of 35 adult patients, concluded that 77% of steroid-resistant patients were improved after treatment with PE. 75 Successful use of PE was also described in some case reports including pediatric cases as well.…”

Section: Immunotherapeutic Approaches Of Chorea As Manifestation Of Omentioning

confidence: 99%

The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data

Vitaliti

Tabatabaie

Matin

et al. 2015

Human Vaccines & Immunotherapeutics

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Plasma exchange for acute attacks of CNS demyelination

Abstract: 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.

Cited by 177 publications

References 16 publications

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Combination therapy for multiple sclerosis in children

The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data

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