Plasma exchange therapy in steroid-unresponsive relapses in patients with multiple sclerosis.

BACKGROUND: Plasma exchange (PE) is well established for conditions such as rapid progressive vasculitis associated with autoantibodies against neutrophil cytoplasmic antigens (ANCA), anti-glomerular basement membrane (GBM) antibody disease, or thrombotic thrombocytopenic purpura (TTP). Also, several neurological disorders, such as acute worsening in myasthenia gravis, Guillan-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), can successfully be treated with PE. Only small case series have previously shown that PE is also effective in relapses in patients with multiple sclerosis (MS). METHODS: We report our experiences of PE therapy in a series of 20 patients with 21 steroid unresponsive MS relapses. RESULTS: A marked-to-moderate clinical response with clear gain of function in 76% of patients with uni- or bilateral optic neuritis and in 87.5% of patients with relapses other than optic neuritis was observed. CONCLUSIONS: PE is an effective and well tolerated therapeutic option for steroid-unresponsive MS relapses.