The Improvement of the Outcome of Osmotic Demyelination Syndrome by Plasma Exchange

Abstract

A 71-year-old Japanese woman presented with progressive fatigue, lethargy, dysarthria and a gait disorder. Her laboratory data revealed hyponatremia (Na 101 mEq/L), and we started correcting her serum sodium level. Within a few days, she became comatose, bedridden, and was intubated. We diagnosed osmotic demyelination syndrome (ODS) and started performing plasma exchange (PE) on the 39th day of hospitalization. She fully recovered after starting PE, and was discharged on foot unassisted. PE can be a beneficial treatment in patients with chronic ODS.

Effective treatment of osmotic demyelination syndrome with plasmapheresis: a case report and review of the literature

“…An unknown myelinotoxic substance in plasma has been postulated to mediate ODS [ 6 ]. This substance is thought to gain access into the CNS by damage to the blood brain barrier and is the possible mechanism of prolonged and ongoing neurotoxicity [ 6 ].…”

“…An unknown myelinotoxic substance in plasma has been postulated to mediate ODS [ 6 ]. This substance is thought to gain access into the CNS by damage to the blood brain barrier and is the possible mechanism of prolonged and ongoing neurotoxicity [ 6 ]. Efficacy of plasmapheresis in ODS is thought to be related to removal of pro-inflammatory, high molecular weight myelinotoxins from the circulation [ 8 ].…”

“…However, successful outcome of chronic ODS is limited to a few case reports [ 6 , 7 ]. Out of the experimental therapies, plasmapheresis alone or in combination with other treatment modalities has shown variable benefit [ 6 , 7 , 8 , 9 , 10 , 11 ]. We report a case of complete clinical and radiological recovery of ODS with plasmapheresis, initiated twenty-two days after rapid sodium correction.…”

“…Apart from supportive therapy, sodium re-lowering therapy has shown to be beneficial in the acute stage [5]. However, successful outcome of chronic ODS is limited to a few case reports [6,7]. Out of the experimental therapies, plasmapheresis alone or in combination with other treatment modalities has shown variable benefit [6,7,8,9,10,11].…”

Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy

“…ODS can manifest 2–6 days after the correction of hyponatraemia 13. The calculation for sodium correction in this patient was aimed to impact serum sodium by less than 10 mmol/L over 24 hours, but that target was overshot.…”