Naslov
STEROID UNRESPONSIVE RELAPSING-REMITTING MULTIPLE SCLEROSIS TREATED WITH PLASMA EXCHANGE: A CASE REPORT AND DISCUSSION OF PATHOPHYSIOLOGY

Autori
Mudrovčić, Monika ; Tomić, Barbara ; Turkalj, Luka ; Horvat Velić, Emina ; Barun, Barbara

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Mind and brain - 56th INTERNATIONAL NEUROPSYCHIATRIC CONGRESS - Abstract book 2016 / Demarin, Vida ; Budinčević, Hrvoje - Zagreb : International Institute for Brain Health, 2016, 89-90

Skup
Mind and brain - 56th INTERNATIONAL NEUROPSYCHIATRIC CONGRESS

Mjesto i datum
Pula, Hrvatska, 15.06.2016. - 18.06.2016

Vrsta sudjelovanja
Poster

Vrsta recenzije
Podatak o recenziji nije dostupan

Ključne riječi
multiple sclerosis, plasma exchange

Sažetak
Introduction/Objectives: Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system.The most common type of MS is relapsing-remitting multiple sclerosis (RRMS), characterized by acute exacerbations of the disease followed by periods of partial or complete recovery. The first-line treatment in relapses is pulse corticosteroid therapy. However, in some relapses, steroid therapy fails to produce a reduction of even one point in the extended disability status scale (EDSS) seven days after application. These are referred to as steroid unresponsive relapses and present a significant therapeutic challenge. One of the possible approaches in these cases is plasma exchange, a method otherwise rarely used in the treatment of MS. While MS was long considered a result of immune processes predominantly mediated by cellular immunity, recent research has shed light on the perhaps equal importance of the humoral component. Neuropathological studies have recognized four distinct lesion patterns in MS, of which pattern II exhibits immunoglobulin and complement deposits within plaques. Participants, Materials/Methods: We present the case of a 41- year-old male patient with an established diagnosis of relapsing remitting multiple sclerosis who experienced four disabling relapses in a 7-month period with EDSS >4. The first clinical manifestation of his disease occurred 3 years earlier and resolved with pulse corticosteroid therapy. Of the four recent flare- ups, two were steroid-unresponsive. In both instances, the decision was made to attempt plasma exchange as a treatment. Results: In both of the steroid-unresponsive relapses the patient displayed marked improvement of clinical status on application of plasma exchange therapy with reduction of EDSS to 2.5. Due to the aggressiveness of the disease, after resolution of the fourth relapse, a course of alemtuzumab Lemtrada) was administered, to which the patient responded well. A year later, he remains clinically and radiologically stable and is due to receive his second course of alemtuzumab. Conclusions: The patient’s good clinical response to plasma exchange therapy, a treatment modality directed solely against humoral immune mechanisms, lends support to the hypothesis that humoral immunity plays a significant role in the pathogenesis of steroid-unresponsive relapses of RRMS. The beneficial effect of monoclonal antibodies on the progression of the disease could result from anti-CD52-mediated B-cell depletion, providing additional support to this concept.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

POVEZANOST RADA