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Plasmapheresis: its use in multiple sclerosis and other demyelinating processes of the central nervous system. An observation study
INTRODUCTION. We present a retrospective observation study aimed at analyzing the value of plasmapheresis in the management of patients with multiple sclerosis (MS) and other acute demyelinating processes affecting the central nervous system (CNS) who show severe exacerbations that do not respond well to conventional therapy with corticoids.
PATIENTS AND METHODS. A total of 11 patients were included in the study: nine with MS, one disseminated acute encephalomyelitis and one case of transverse myelitis. All of them presented an acute or subacute neurological deficit, which prevented them from carrying out their day-to-day activities, with or without repercussions on the EDSS, and with the risk of suffering a severe residual disability after not responding to intravenous methylprednisolone pulses. Each patient was submitted to three exchanges per week, for 2 weeks, with association of orally-administered prednisone and they were then evaluated after the last session and at one, six and twelve months.
RESULTS. Following plasmapheresis all the patients experienced a significant drop in disability and seven of them (77.7% of the total number with MS) even improved during the first month with respect to their basal situation (‘an extension of the Lazarus effect’). After a year’s follow-up, 100% of the patients still maintained the basal situation that was recovered from before exacerbation, and only two relapses were recorded. The patients with MS presented a ‘transient exacerbation’ after the second exchange. New therapy with immunosuppressants, immunomodulators or both was associated in eight cases.