What is it about?

This article aims at comparing the efficacy of combined plasma exchange and high dose steroids to high dose steroids only for treatment of acute relapses in neuromyelitis optica (NMO).

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Why is it important?

Although adding plasma exchange in steroid-resistant NMO relapses is considered common practice, the evidence behind this technique has been weak or lacking. In this study we provide a measurable difference in efficacy between the two treatment regimens based on EDSS improvement at the time of hospital discharge and on follow up. We have shown that adding plasma exchange to steroid treatment is much more likely to bring patient's disability back to baseline even in patients with severe relapses. We also demonstrated that patients on long term immunosuppression seemed to benefit more from plasma exchange during acute relapse than patients who were not on such medications. We hope that this study will lower the threshold for utilizing plasma exchange for acute NMO relapses and translate into improved patient outcomes.

Perspectives

Treatment of acute relapses in NMO is of particular importance since NMO is a pure inflammatory disease without ongoing neurodegeneration in between attacks. Unlike MS, patient's disability in NMO results from accumulating residual deficits following each relapse. Improving the outcome after each relapse is key for prevention of disability accumulation in NMO.

Dr Hesham Abboud
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Read the Original

This page is a summary of: Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange, Multiple Sclerosis Journal, April 2015, SAGE Publications,
DOI: 10.1177/1352458515581438.
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