ADC restriction is not associated with clinical response to plasma exchange following a cerebral attack of multiple
Caitlin Jackson-Tarlton1, Diana Londoño2, Claudia F Lucchinetti3
1Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Background:
MS is the most common CNS inflammatory demyelinating disease. Plasma exchange (PLEX) has well-demonstrated efficacy in acute corticosteroid-refractory attacks of demyelination but identifying the factors that predict favorable PLEX response remains elusive. We aimed to determine if apparent diffusion coefficient (ADC) restriction on brain MRI predicts clinical response to PLEX in individuals with an acute cerebral attack of MS.
Methods:
Retrospective chart review of individuals with a cerebral attack of MS who underwent PLEX at Mayo Clinic.
Results:
We identified 34 individuals who fulfilled the inclusion criteria. Twenty-seven (79%) responded to plasma exchange, with 16/34 (47%) having moderate and 11/34 (32%) marked improvement. Twenty-three (68%) people had ADC restriction on brain MRI prior to PLEX. ADC restriction did not predict response (p = 0.51). Several other pre-PLEX factors, including sex, Expanded Disability Status Scale (EDSS) at initial attack, time to PLEX, and concurrent spinal cord attack, also failed to predict response. Plasma-exchange responders had less disability at 6-month follow-up compared to non-responders (median EDSS 2.5 (range 1.0-10.0) vs. 7.5 (5.5-10.0), p<0.001).
Conclusion:
Acute cerebral attacks of MS have a high rate of plasma exchange response resulting in a lower EDSS at 6-months. ADC restriction does not predict response to plasma exchange.
Insights
Plasma exchange (PLEX) effectively treats acute MS attacks, leading to better long-term outcomes. However, apparent diffusion coefficient (ADC) restriction on MRI does not predict PLEX response in these patients.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Multiple Sclerosis (MS) is a leading cause of CNS inflammatory demyelination.
- Plasma exchange (PLEX) is effective for acute, corticosteroid-refractory MS attacks.
- Predictors of favorable PLEX response in MS remain unclear.
Purpose of the Study:
- To investigate if apparent diffusion coefficient (ADC) restriction on brain MRI predicts clinical response to PLEX in acute MS cerebral attacks.
Main Methods:
- Retrospective chart review of MS patients undergoing PLEX at Mayo Clinic.
- Analysis of pre-PLEX MRI for ADC restriction.
- Evaluation of clinical response and 6-month follow-up outcomes.
Main Results:
- 34 MS patients met inclusion criteria; 79% responded to PLEX.
- 47% showed moderate and 32% marked improvement.
- ADC restriction (68% of patients) did not predict PLEX response (p=0.51).
- Other factors like sex, EDSS, time to PLEX, and concurrent spinal cord attacks also failed to predict response.
- PLEX responders had significantly lower 6-month EDSS scores compared to non-responders (2.5 vs. 7.5, p<0.001).
Conclusions:
- Acute MS cerebral attacks demonstrate a high response rate to PLEX, correlating with reduced long-term disability.
- Apparent diffusion coefficient (ADC) restriction on pre-treatment MRI is not a predictor of PLEX efficacy in MS.
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