December 1, 1999Annals of Neurology
A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease
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Discussion
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Implication
Randomized double-blind trial reveals plasma exchange improves neurological recovery in steroid-unresponsive demyelinating disease, indicating its efficacy as rescue therapy.
Key Points
- To assess the efficacy of plasma exchange without concomitant immunosuppression in treating severe, acute neurological deficits from central nervous system inflammatory demyelinating disease unresponsive to corticosteroids.
- Conducted a randomized, sham-controlled, double-masked crossover study of plasma exchange without concurrent immunosuppressive therapy.
- Enrolled patients with severe, recently acquired neurological deficits from demyelinating attacks who failed to recover after intravenous corticosteroid treatment, crossing non-responders over to the alternate arm.
- Moderate or greater improvement in neurological disability occurred during 8 of 19 (42.1%) courses of active plasma exchange compared with 1 of 17 (5.9%) courses of sham treatment.
- Functional improvements occurred early in active treatment and were sustained over follow-up, though 4 responding patients experienced new demyelinating attacks within 6 months.
- Among patients who failed to improve during the active treatment phase, only 2 of 13 achieved moderate or greater improvement during subsequent follow-up.
Cite This Study
Weinshenker et al. (1999) studied this question.