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Open AccessArticle

Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety

1
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
2
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
3
Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, 2130 Mistelbach, Austria
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(10), 267; https://doi.org/10.3390/brainsci9100267
Received: 1 September 2019 / Revised: 23 September 2019 / Accepted: 8 October 2019 / Published: 9 October 2019
(This article belongs to the Special Issue Advances in Multiple Sclerosis Research)
Therapeutic plasma exchange (TPE) is a well-established method of treatment for steroid-refractory relapses in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Little is known about indications and clinical responses to TPE in autoimmune encephalitis and other immune-mediated disorders of the central nervous system (CNS). We performed a retrospective chart review of patients with immune-mediated disorders of the CNS undergoing TPE at our tertiary care center between 2003 and 2015. The response to TPE within a 3- to 6-month follow-up was scored with an established rating system. We identified 40 patients including 21 patients with multiple sclerosis (MS, 52.5%), 12 with autoimmune encephalitis (AE, 30%), and 7 with other immune-mediated CNS disorders (17.5%). Among patients with AE, eight patients had definite AE (Immunolobulin G for N-methyl-D-aspartate receptor n = 4, Leucine-rich, glioma inactivated 1 n = 2, Ma 2 n = 1, and Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid n = 1). Intravenous immunoglobulins had been given prior to TPE in all but one patient with AE, and indications were dominated by acute psychosis and epileptic seizures. While TPE has a distinct place in the treatment sequence of different immune-mediated CNS disorders, we found consistent efficacy and safety. Further research should be directed toward alternative management strategies in non-responders. View Full-Text
Keywords: multiple sclerosis; autoimmune encephalitis; plasma exchange; autoimmunity; immunotherapeutics; clinical outcomes multiple sclerosis; autoimmune encephalitis; plasma exchange; autoimmunity; immunotherapeutics; clinical outcomes
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Moser, T.; Harutyunyan, G.; Karamyan, A.; Otto, F.; Bacher, C.; Chroust, V.; Leitinger, M.; Novak, H.F.; Trinka, E.; Sellner, J. Therapeutic Plasma Exchange in Multiple Sclerosis and Autoimmune Encephalitis: A Comparative Study of Indication, Efficacy, and Safety. Brain Sci. 2019, 9, 267.

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