summary: The most common treatment after an acute attack of central nervous system demyelination (i.e. a relapse of MS) is a high dose of intravenous steroids. However, when the attack provokes severe neurological deficits, the response to the intravenous steroids may be insufficient. In these cases, plasma exchange (PE), a measure to selectively clean the blood of antibodies (known to be related to acute demyelinating events), can have positive effects, as was shown in a double blind controlled trial published in 1999. PE has been frequently used as a treatment for these severe attacks that are unresponsive to intravenous steroids. The authors aimed to investigate the efficacy of PE and factors relating to a better outcome after PE treatment. They retrospectively studied a group of 41 people who received this treatment in a given MS centre. They found that, after PE treatment, almost 40% had an improvement during the first few weeks, which was evident from the time of discharge (one to five weeks after treatment). Interestingly, when the whole group was evaluated six months after treatment, this improvement had actually been achieved in more than 60%, revealing that a significant amount of people who had not improved at the beginning did later show improvement. Although this late improvement is encouraging and reinforces the potential role of this treatment when severe attacks unresponsive to steroids occur, the authors also found that the early improvement after the PE was the best predictor of a better late response to it.

authors: Llufriu S, Castillo J, Blanco Y, Ramió-Torrentà L, Río J, Vallès M, Lozano M, Castellà MD, Calabia J, Horga A, Graus F, Montalban X, Saiz A

source: Neurology. 2009 Sep 22;73(12):949-53

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