Therapeutic efficacy of double filtration plasmapheresis in patients with anti-aquaporin-4 antibody-positive multiple sclerosis

Munemoto, Masashi; Otaki, Yoshinaga; Kasama, Shuhei; Nanami, Masayoshi; Tokuyama, Masanori; Yahiro, Mana; Hasuike, Yukiko; Kuragano, Takahiro; Yoshikawa, Hiroaki; Nonoguchi, Hiroshi; Nakanishi, Takeshi

doi:10.1016/j.jocn.2010.07.141

Cited by 28 publications

(18 citation statements)

References 13 publications

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“…A small number of case reports and few small studies were reported with variable issues. Judging improvement is even more complex due to the subjective classification of improvement in mild/moderate/marked instead of a quantified clinical exam [26, 34–36]. Moreover the natural history of single spinal relapse in NMO has never been addressed, so any improvement bias after PLEX is inappreciable in the absence of a control group.…”

Section: Plex In Severe Attacksmentioning

confidence: 99%

Plasma Exchange in Severe Attacks of Neuromyelitis Optica

Bonnan¹,

Cabre

2012

Multiple Sclerosis International

115

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Background. Neuromyelitis optica (NMO) attacks are poorly controlled by steroids and evolve in stepwise neurological impairments. Assuming the strong humoral response underlying NMO attacks, plasma exchange (PLEX) is an appropriate technique in severe NMO attacks. Objective. Presenting an up-to-date review of the literature of PLEX in NMO. Methods. We summarize the rationale of PLEX in relation with the physiology of NMO, the main technical aspects, and the available studies. Results. PLEX in severe attacks from myelitis or optic neuritis are associated with a better outcome, depending on PLEX delay (“time is cord and eyes”). NMO-IgG status has no influence. Finally, we build up an original concept linking the inner dynamic of the lesion, the timing of PLEX onset and the expected clinical results. Conclusion. PLEX is a safe and efficient add-on therapy in NMO, in synergy with steroids. Large therapeutic trials are required to definitely assess the procedure and define the time opportunity window.

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Section: Plex In Severe Attacksmentioning

confidence: 99%

Plasma Exchange in Severe Attacks of Neuromyelitis Optica

Bonnan¹,

Cabre

2012

Multiple Sclerosis International

115

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“…In contrast to conventional plasma exchange, which uses one plasma separator filter, double-filtration plasmapheresis uses two types of separator filter. The second filter selectively removes high-molecular-weight proteins, including inflammatory cytokines 101. Eight patients were treated with double-filtration plasmapheresis for a maximum of seven times per month for 3 months, and 3,000-4,000 mL of plasma were exchanged at each session.…”

Section: Managementmentioning

confidence: 99%

New Insights into Neuromyelitis Optica

Kim

2011

J Clin Neurol

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Neuromyelitis optica (NMO) is an idiopathic inflammatory disorder of the central nervous system (CNS) that preferentially affects the optic nerves and spinal cord. In Asia, NMO has long been considered a subtype of multiple sclerosis (MS). However, recent clinical, pathological, immunological, and imaging studies have suggested that NMO is distinct from MS. This reconsideration of NMO was initially prompted by the discovery of a specific antibody for NMO (NMO-IgG) in 2004. NMO-IgG is an autoantibody that targets aquaporin-4 (AQP4), the most abundant water channel in the CNS; hence, it was named anti-AQP4 antibody. Since it demonstrated reasonable sensitivity and high specificity, anti-AQP4 antibody was incorporated into new diagnostic criteria for NMO.The spectrum of NMO is now known to be wider than was previously recognized and includes a proportion of patients with recurrent, isolated, longitudinally extensive myelitis or optic neuritis, and longitudinally extensive myelitis or optic neuritis associated with systemic autoimmune disease or with brain lesions typical of NMO. In this context, a new concept of "NMO spectrum disorders" was recently introduced. Furthermore, seropositivity for NMO-IgG predicts future relapses and is recognized as a prognostic marker for NMO spectrum disorders. Humoral immune mechanisms, including the activation of B-cells and the complement pathway, are considered to play important roles in NMO pathogenesis. This notion is supported by recent studies showing the potential pathogenic role of NMO-IgG as an initiator of NMO lesions. However, a demonstration of the involvement of NMO-IgG by the development of active immunization and passive transfer in animal models is still needed. This review focuses on the new concepts of NMO based on its pathophysiology and clinical characteristics. Potential management strategies for NMO in light of its pathomechanism are also discussed.

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“…There are many studies that showed changes of AQP4 and oligoclonal bands titre after TPE (Yoshida et al, 2010;Munemoto et al, 2011), which was not analysed in the present study as the oligoclonal band test was not made for all patients.…”

Section: Nomentioning

confidence: 95%

First Experience and the Effectiveness of Immunomodulating Treatment in Inflammatory Demyelinating CNS Diseases: Analysis of Nine Patients / Imūnmodulējošās Terapijas Efektivitāte Centrālās Nervu Sistēmas Iekaisīgu Saslimšanu Gadījumos: Deviņu Pacientu Analīze

Vainšteine

Kostiks

Karelis

et al. 2015

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Therapeutic plasma exchange (TPE) is used in many neurological disorders to remove immunoglobulin and other immunologically active substances. We observed patients that were admitted in Rīga East Clinical University Hospital “Gaiļezers”, Clinic of Neurology and Neurosurgery, Multiple Sclerosis Unit, and were diagnosed with relapsing remitting multiple sclerosis (MS), according to McDonald criteria 2010 (five patients), Neuromyelitis optica (NMO) spectrum disorders (three patients) and one with NMO, according to Wingerchuk 2006 criteria. All relapses were confirmed according to clinical criteria. Visual acuity was assessed by an ophthalmologist, and neurological status by a neurologist. All patients received at least 1 cycle of 1000 mg methylprednisolone intravenous for five to seven days. The expanded disability status scale score in the MS patient group was in range 4.0-9.0 before TPE and 3.5-6.5 range after TPE. Best improvement was observed in the MS group: mean symptom reduction of 20%. Patients with NMO spectrum disorder had an EDSS score of 8.0-8.5 range on admission and 6.5-8.0 range after TPE. After one month, one patient in the NMO spectrum disorder group had good response to TPE and EDSS was 3.5, two patients had only slight improvement (EDSS scores 8.0 and 7.5). Condition of patients with NMO did not improve even after a month.

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Therapeutic efficacy of double filtration plasmapheresis in patients with anti-aquaporin-4 antibody-positive multiple sclerosis

Cited by 28 publications

References 13 publications

Plasma Exchange in Severe Attacks of Neuromyelitis Optica

Plasma Exchange in Severe Attacks of Neuromyelitis Optica

New Insights into Neuromyelitis Optica

First Experience and the Effectiveness of Immunomodulating Treatment in Inflammatory Demyelinating CNS Diseases: Analysis of Nine Patients / Imūnmodulējošās Terapijas Efektivitāte Centrālās Nervu Sistēmas Iekaisīgu Saslimšanu Gadījumos: Deviņu Pacientu Analīze

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