Plasma Exchange in Multiple Sclerosis

Q: Give at least three indications of plasma exchange (PLEX) in acute exacerbation of multiple sclerosis (MS)?

Answer: PLEX is not the first line treatment for acute exacerbation of MS, but it can be very vital in the following situations

• Partial or no response to treatment with high-dose glucocorticoids 
• Large, tumefactive lesions 
• Severe deficits, i.e., hemiplegia, paraplegia, quadriplegia, coma, aphasia, or severe cognitive dysfunction
• Optic neuritis with severe visual impairment.

A neurologist should be consulted to decide on the frequency and monitoring of PLEX. 

#neurology

References:

1. Arrambide G, Iacobaeus E, Amato MP, et al. Aggressive multiple sclerosis (2): Treatment. Mult Scler 2020; :1352458520924595.

2. Bevan C, Gelfand JM. Therapeutic management of severe relapses in multiple sclerosis. Curr Treat Options Neurol 2015; 17:345.

3. Cortese I, Chaudhry V, So YT, et al. Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76:294.

4. Ehler J, Koball S, Sauer M, et al. Response to Therapeutic Plasma Exchange as a Rescue Treatment in Clinically Isolated Syndromes and Acute Worsening of Multiple Sclerosis: A Retrospective Analysis of 90 Patients. PLoS One 2015; 10:e0134583.