Moser Tobias, Harutyunyan Gayane, Karamyan Anush, Otto Ferdinand, Bacher Carola, Chroust Vaclav, Leitinger Markus, Novak Helmut F, Trinka Eugen, Sellner Johann
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria.
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 81675 Mücnhen, Germany.
Brain Sci. 2019 Oct 9;9(10):267. doi: 10.3390/brainsci9100267.
Therapeutic plasma exchange (TPE) is a well-established method of treatment for steroid-refractory relapses in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Little is known about indications and clinical responses to TPE in autoimmune encephalitis and other immune-mediated disorders of the central nervous system (CNS). We performed a retrospective chart review of patients with immune-mediated disorders of the CNS undergoing TPE at our tertiary care center between 2003 and 2015. The response to TPE within a 3- to 6-month follow-up was scored with an established rating system. We identified 40 patients including 21 patients with multiple sclerosis (MS, 52.5%), 12 with autoimmune encephalitis (AE, 30%), and 7 with other immune-mediated CNS disorders (17.5%). Among patients with AE, eight patients had definite AE (Immunolobulin G for N-methyl-D-aspartate receptor = 4, Leucine-rich, glioma inactivated 1 = 2, Ma 2 = 1, and Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid = 1). Intravenous immunoglobulins had been given prior to TPE in all but one patient with AE, and indications were dominated by acute psychosis and epileptic seizures. While TPE has a distinct place in the treatment sequence of different immune-mediated CNS disorders, we found consistent efficacy and safety. Further research should be directed toward alternative management strategies in non-responders.
治疗性血浆置换（TPE）是治疗多发性硬化症（MS）和视神经脊髓炎谱系障碍（NMOSD）中类固醇难治性复发的一种成熟方法。对于自身免疫性脑炎和其他中枢神经系统（CNS）免疫介导性疾病中TPE的适应症和临床反应知之甚少。我们对2003年至2015年期间在我们三级医疗中心接受TPE的中枢神经系统免疫介导性疾病患者进行了回顾性病历审查。采用既定的评分系统对3至6个月随访期间对TPE的反应进行评分。我们确定了40例患者，其中包括21例多发性硬化症患者（MS，52.5%）、12例自身免疫性脑炎患者（AE，30%）和7例其他免疫介导性中枢神经系统疾病患者（17.5%）。在AE患者中，8例为确诊的AE（抗N-甲基-D-天冬氨酸受体免疫球蛋白G = 4，富亮氨酸胶质瘤失活蛋白1 = 2，Ma 2 = 1，α-氨基-3-羟基-5-甲基-4-异恶唑丙酸 = 1）。除1例AE患者外，所有患者在TPE之前均接受过静脉注射免疫球蛋白，适应症主要为急性精神病和癫痫发作。虽然TPE在不同免疫介导性中枢神经系统疾病的治疗序列中有独特地位，但我们发现其疗效和安全性具有一致性。应针对无反应者的替代管理策略开展进一步研究。
