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Relación entre los cambios patológicos humoral en la esclerosis múltiple y la respuesta al intercambio terapéutico de
Mark Keegan1, Fatima König, Robyn McClelland
1Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Lancet (London, England)
|August 16, 2005
Resumen
El intercambio terapéutico de plasma (TPE, por sus siglas en inglés) es prometedor para el tratamiento de los ataques graves de esclerosis múltiple. Los pacientes con desmielinización de patrón II, caracterizada por deposición de inmunoglobulina y complemento, mostraron una mejora significativa con TPE.
Área de la Ciencia:
- Neurología Neurología.
- Inmunopatología Inmunopatología.
- Enfermedades desmielinizantes Las enfermedades desmielinizantes.
Sus antecedentes:
- Las lesiones de esclerosis múltiple (EM) exhiben diversos patrones inmunopatológicos.
- Estos patrones sugieren una heterogeneidad patógena subyacente en la EM.
- El intercambio terapéutico de plasma (TPE) es efectivo para los ataques desmielinizantes graves que no responden a los esteroides.
Objetivo del estudio:
- Para investigar la eficacia del TPE en pacientes con enfermedad inflamatoria desmielinizante fulminante del sistema nervioso central (SNC).
- Para determinar si los patrones inmunopatológicos específicos predicen la respuesta al TPE.
Principales métodos:
- Estudio retrospectivo de 19 pacientes con enfermedad inflamatoria desmielinizante fulminante del SNC tratados con TPE.
- Clasificación de la desmielinización en patrones inmunopatológicos (I, II, III).
- Evaluación de la mejora neurológica funcional después de la TPE.
Principales resultados:
- Los 10 pacientes con lesiones de patrón II mostraron una mejora neurológica de moderada a sustancial después de TPE.
- Ningún paciente con lesiones de patrón I (n=3) o patrón III (n=6) mejoró.
- Se observó una diferencia significativa en la respuesta a TPE entre el patrón II y otros patrones (p<0.0001).
Conclusiones:
- Los pacientes con esclerosis múltiple con patología de patrón II tienen más probabilidades de responder favorablemente al TPE.
- Las lesiones del patrón II, marcadas por inmunoglobulina y deposición del complemento, pueden identificar a los pacientes que se benefician del TPE.
- TPE es un tratamiento potencial para los ataques de esclerosis múltiple fulminante en pacientes con perfiles inmunopatológicos específicos.
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