When is the next Split of MS

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Many years ago optico-spinal MS was called Devics MS and now it is called Neuromyelitis Optica. Here many people make antibodies to aquaporin 4, but a few people also make antibodies to myelin oligodendrocyte glycoprotein (MOG). In this study they report that some people who are diagnosed with MS, respond to plasma exchange. Here you separate the blood plasma (PLEX) from the cells, you return the cells with fake plasma and so reduce what is pathogenic in the blood. This implies there are pathogenic antibodies. So once you define them you can maybe split MS into a small pot. The importance iswhen it comes to treatment. There is nopoint in doing PLEX in people who wont respond or giving treatment who wont respond or importantly respond badly.

Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response.

Palacios-Mendoza MA, Martínez Ginés ML, Melgarejo Otálora PJ, Cuello JP, Sánchez-Soblechero A, Lozano Ros A, Aparcero-Suero JA, López Anguita S, Anaya F, García Domínguez JM.Neurol Sci. 2020 Apr 4. doi: 10.1007/s10072-020-04382-w. [Epub ahead of print].

BACKGROUND: Plasma exchange (PLEX) is a therapeutic option in the treatment of acute attacks of Demyelinating Diseases of the Central Nervous System (DDCNS). Factors related with PLEX response are not well established.

METHODS:Descriptive and retrospective study. We included patients treated with PLEX for acute attacks of DDCNS between 2008 and 2017. We recorded demographics, clinical and treatment-related data, and Expanded Disability Status Scale (EDSS) score at admission, at discharge, and at 6 months.

RESULTS:We included 64 patients. Forty-eight (75%) were female with a mean age of 48.28 ± 11.5 years. Half of our patients were diagnosed with multiple sclerosis. Clinical improvement was achieved in 51.6% at discharge and 62.5% at 6 months. The logistic regression model showed that EDSS score > 3 at admission (p = 0.04) and early clinical improvement with PLEX (p = 0.00) were predictors of good response to PLEX at discharge and at 6 months, respectively. No serious adverse effects were identified.

CONCLUSIONS: PLEX is a safe and effective treatment for acute attacks of DDCNS. EDSS score at admission and early clinical improvement with PLEX were factors associated with good response to PLEX.

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