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Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety

Therapeutic plasma exchange (TPE) is a well-established method of treatment for steroid-refractory relapses in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Little is known about indications and clinical responses to TPE in autoimmune encephalitis and other immune-medi...

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Autores principales: Moser, Tobias, Harutyunyan, Gayane, Karamyan, Anush, Otto, Ferdinand, Bacher, Carola, Chroust, Vaclav, Leitinger, Markus, Novak, Helmut F., Trinka, Eugen, Sellner, Johann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827054/
https://www.ncbi.nlm.nih.gov/pubmed/31601005
http://dx.doi.org/10.3390/brainsci9100267
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author Moser, Tobias
Harutyunyan, Gayane
Karamyan, Anush
Otto, Ferdinand
Bacher, Carola
Chroust, Vaclav
Leitinger, Markus
Novak, Helmut F.
Trinka, Eugen
Sellner, Johann
author_facet Moser, Tobias
Harutyunyan, Gayane
Karamyan, Anush
Otto, Ferdinand
Bacher, Carola
Chroust, Vaclav
Leitinger, Markus
Novak, Helmut F.
Trinka, Eugen
Sellner, Johann
author_sort Moser, Tobias
collection PubMed
description Therapeutic plasma exchange (TPE) is a well-established method of treatment for steroid-refractory relapses in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Little is known about indications and clinical responses to TPE in autoimmune encephalitis and other immune-mediated disorders of the central nervous system (CNS). We performed a retrospective chart review of patients with immune-mediated disorders of the CNS undergoing TPE at our tertiary care center between 2003 and 2015. The response to TPE within a 3- to 6-month follow-up was scored with an established rating system. We identified 40 patients including 21 patients with multiple sclerosis (MS, 52.5%), 12 with autoimmune encephalitis (AE, 30%), and 7 with other immune-mediated CNS disorders (17.5%). Among patients with AE, eight patients had definite AE (Immunolobulin G for N-methyl-D-aspartate receptor n = 4, Leucine-rich, glioma inactivated 1 n = 2, Ma 2 n = 1, and Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid n = 1). Intravenous immunoglobulins had been given prior to TPE in all but one patient with AE, and indications were dominated by acute psychosis and epileptic seizures. While TPE has a distinct place in the treatment sequence of different immune-mediated CNS disorders, we found consistent efficacy and safety. Further research should be directed toward alternative management strategies in non-responders.
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spelling pubmed-68270542019-11-18 Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety Moser, Tobias Harutyunyan, Gayane Karamyan, Anush Otto, Ferdinand Bacher, Carola Chroust, Vaclav Leitinger, Markus Novak, Helmut F. Trinka, Eugen Sellner, Johann Brain Sci Article Therapeutic plasma exchange (TPE) is a well-established method of treatment for steroid-refractory relapses in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Little is known about indications and clinical responses to TPE in autoimmune encephalitis and other immune-mediated disorders of the central nervous system (CNS). We performed a retrospective chart review of patients with immune-mediated disorders of the CNS undergoing TPE at our tertiary care center between 2003 and 2015. The response to TPE within a 3- to 6-month follow-up was scored with an established rating system. We identified 40 patients including 21 patients with multiple sclerosis (MS, 52.5%), 12 with autoimmune encephalitis (AE, 30%), and 7 with other immune-mediated CNS disorders (17.5%). Among patients with AE, eight patients had definite AE (Immunolobulin G for N-methyl-D-aspartate receptor n = 4, Leucine-rich, glioma inactivated 1 n = 2, Ma 2 n = 1, and Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid n = 1). Intravenous immunoglobulins had been given prior to TPE in all but one patient with AE, and indications were dominated by acute psychosis and epileptic seizures. While TPE has a distinct place in the treatment sequence of different immune-mediated CNS disorders, we found consistent efficacy and safety. Further research should be directed toward alternative management strategies in non-responders. MDPI 2019-10-09 /pmc/articles/PMC6827054/ /pubmed/31601005 http://dx.doi.org/10.3390/brainsci9100267 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Moser, Tobias
Harutyunyan, Gayane
Karamyan, Anush
Otto, Ferdinand
Bacher, Carola
Chroust, Vaclav
Leitinger, Markus
Novak, Helmut F.
Trinka, Eugen
Sellner, Johann
Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title_full Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title_fullStr Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title_full_unstemmed Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title_short Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety
title_sort therapeutic plasma exchange in multiple sclerosis and autoimmune encephalitis: a comparative study of indication, efficacy, and safety
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827054/
https://www.ncbi.nlm.nih.gov/pubmed/31601005
http://dx.doi.org/10.3390/brainsci9100267
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