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Plasma exchange of malignant multiple sclerosis
Abstract:
A 17-year old female with "malignant" multiple sclerosis died 45 weeks after the onset of the disease. Postmortem examination confirmed the clinical diagnosis of multiple sclerosis. After 30 weeks of rapid clinical progression, the patient was treated with two courses of plasma exchange therapy without immunosuppression. This form of therapy caused a drop in cerebrospinal fluid myelin basic protein levels in one instance, but not in another. Controlled clinical trials are required to determine whether plasma exchange therapy is of value in the management of patients with multiple sclerosis, and the monitoring of cerebrospinal fluid myelin basic protein, if elevated, may be one useful marker to follow as part of these studies.
Insights
Plasma exchange therapy showed variable effects on cerebrospinal fluid myelin basic protein in a severe multiple sclerosis case. Further controlled trials are needed to assess its therapeutic value in managing multiple sclerosis.
Area of Science:
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
- Malignant MS presents with rapid progression and poor prognosis.
Observation:
- A 17-year-old female with malignant multiple sclerosis experienced rapid disease progression over 30 weeks.
- The patient underwent two courses of plasma exchange therapy without immunosuppression.
- Cerebrospinal fluid (CSF) myelin basic protein (MBP) levels were monitored during treatment.
Findings:
- Plasma exchange therapy resulted in a decrease in CSF MBP levels in one instance.
- The therapeutic effect on CSF MBP levels was inconsistent across treatment courses.
- Postmortem examination confirmed the diagnosis of multiple sclerosis.
Implications:
- Controlled clinical trials are necessary to evaluate the efficacy of plasma exchange therapy in multiple sclerosis management.
- Monitoring CSF MBP levels may serve as a potential biomarker in future therapeutic studies for MS.