Plasma Exchange in a Patient with Tumefactive, Corticosteroid-Resistant Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease that typically has a relapsing and remitting course at onset. Disability can accumulate quickly if relapses are severe and recovery is incomplete, but any relapse may result in accumulation of disability.1 Tumefactive MS is a particularly aggressive form, characterized by large (>2 cm), tumor-like demyelinating lesions seen on magnetic resonance imaging (MRI).2 These lesions may occur as solitary or multiple lesions. 2Standard treatment for MS relapses consists of highdose corticosteroids; however, this treatment may not be effective for these severe relapses, and additional treatment options in these situations should be explored. Plasma exchange (PLEX) is beneficial in severe, corticosteroid-resistant relapses of MS and neuromyelitis optica (NMO); however, there are few reports of its use in tumefactive MS. [2][3][4] We describe a fulminant course of MS with multiple tumefactive lesions treated with PLEX. Case ReportA 46-year-old right-handed woman was referred to our tertiary-care center for continued management of a severe MS relapse. She had recently been diagnosed as having relapsing-remitting MS (RRMS) based on two relapses in the preceding 10 months, as well as CASE REPORT

What speech can tell us: A systematic review of dysarthria characteristics in Multiple Sclerosis

“…Resistive respiratory training showed better results than non-resistive exercises. One study tested an integrated protocol of respiratory, phonatory and articulatory exercises in Finally, a single case of acute relapse-related dysarthria (among other symptoms) was successfully treated with plasma exchange after failure to improve with corticosteroids (65). Schmidt and colleagues (66) reported good results using the potassium channel agonist, Fampridine, in three cases of severe dysarthria.…”

Neurological safety of fingolimod: An updated review

“…No standard treatment exists, but high‐dose intravenous corticosteroids (methylprednisolone 1 g for 3–5 days) followed by oral tapering hasten clinical and radiological improvement in approximately 80% of patients 39. Plasma exchange (PLEX) has been used in the absence of response to corticosteroids 40. Some patients with tumefactive demyelination refractory to corticosteroids or PLEX might still benefit from rituximab 41…”

Management of recurrent tumefactive multiple sclerosis: Case report and literature review

“…Then, prednisone was used with AZA during 1 year, and in the subsequent 5 months of follow-up, AZA was used alone in a dosage of 150 mg/day. [ 1 ] Another case report also suggested the use of AZA when corticosteroid alone fails in the management of tumefactive MS.[ 8 ]…”