First Experience and the Effectiveness of Immunomodulating Treatment in Inflammatory Demyelinating CNS Diseases : Analysis of Nine Patients

Abstract

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 Riga East Clinical University Hospital "Gaiezers", 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.