[Plasma exchanges in severe and acute inflammatory demyelinating attacks of the central nervous system]

They are severe inflammatory demyelinating diseases of the central nervous system, often called idiopathic inflammatory demyelinating disease (IIDD). These diseases are explosive or pseudotumoral multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), transverse myelitis and neuromyelitis optica (NMO). The usual therapeutic are intraveinous corticosteroids. Sometimes, these diseases are unresponsive to corticosteroids and it is necessary to use more incisive immunoactive treatment such as the plasma exchanges (PE).

We retrospectively reviewed the medical records of 35 patients (10 of Dijon and 25 of Lyon) corresponding to the definition of IIDD and having treated by PE after failure of corticosteroids.

Seventy-four percent of the patients were women, the median age was 38years. Forty-three percent of the patients had MS, 31.5% NMO, 14% ADEM and 11.5% a transverse myelitis. The response of the PE was favorable in 77% of the cases (moderate or marked improvement, at 1month, 3months and more than 6months). They are well tolerated.

Early initiation of PE seems to be a predictor of a good response.