Clinical outcomes and predictive factors related to good outcomes in plasma exchange in severe attack of NMOSD and long extensive transverse myelitis: Case series and review of the literature

The establishment of in‐house neurology driven therapeutic plasma exchange infrastructure in a resource‐limited public hospital in Malaysia: Adopting and integrating evidenced‐based health care technology through time

“…We increasingly perform TPE for CNS related immune disorders, that is, a great majority with NMOSD and transverse myelitis. This was supported with recent evidence of its efficacy and outcome which was time‐dependent . We performed lesser number of TPE's for patients with PNS mainly due to two reasons; local treatment protocols and patient‐selection.…”

“…With the emergence of increasing new knowledge associating various CNS disorders with specific autoantibodies, the use of TPE has become increasingly important. TPE is currently used in the treatment of acute NMOSD, autoimmune encephalitis and other aggressive cases of immune‐mediated CNS demyelinating diseases not responding to initial corticosteroid treatment . The discovery of various pathogenic antibodies such as the antibody against the water channel aquaporin‐4 in patients with NMOSD, the antibody against NMDA receptors and voltage‐gated potassium channels in autoimmune encephalitis supports the use of TPE in these diseases.…”

Plasma exchange as a first line therapy in acute attacks of neuromyelitis optica spectrum disorders

“…[21] Also evident from the results of the present study; the time to PLEX has significantly influenced the outcome, ranging from immediate dramatic improvement (the Lazarus effect) to no effect according to whether they are given early or very late, with shorter delay leading to better outcomes similar to other studies. [142223] However, further prospective, randomized, multicentre clinical trials would be required to definitively answer this question in a better way. For example, PLEX was delayed from onset by a median of 30 days (6-90 days) in Llufriu et al ; in their study, early initiation of PLEX [Odds Ratio (OR) 6.29, 95% Confidence Interval (CI) 1.18-52.96] and improvement at discharge [OR 7.32, 95% CI 1.21-44.38] were significantly associated at 6 months.…”

Second regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders, Kuala Lumpur, Malaysia, 9th December 2017

“…Although TPE has been proven to be effective in patients with acute relapses of NMOSD, the role of TPE in RRMS is also gaining ground . Metha Apiwattanakul (MA), Consultant Neurologist from the Prasat Neurological Institute, Thailand summarized the complex, but ground breaking immunopathogenesis of NMOSD and multiple sclerosis (MS) .…”

“…He explained in detail the role of pathogenic anti‐antibody Aquaporin 4 (AQP4)‐IgG binding in NMOSD and its effect on astrocytic death after gaining entry through the human blood brain barrier (BBB). He also provided the encouraging high‐quality trial data on the role of TPE in treating acute central nervous system inflammatory demyelinating diseases, particularly in patients with acute presentation NMOSD, Optic Neuritis and transverse myelitis . Although no pathogenic auto‐antibody had yet been identified in patients with MS, evidence is available recommending the use of TPE in patients with acute exacerbations after failing to response to corticosteroid first‐line treatment.…”