Contributions
Abstract: P974
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory disorders of the central nervous system characterized by acute attacks to the optic nerve and longitudinally extensive myelitis. In general, attacks are treated with high-dose intravenous glucocorticoids followed by plasma exchange (PLEX) in case of refractoriness. Recently, the possibility of starting with steroids associated to plasma exchange has been raised in order to impact on severe outbreaks.
Objective: To compare the outcome of relapses in patients with NMOSD treated with steroids versus PLEX.
Methods: A retrospective review of patients with NMOSD records was made. Data of all admissions to the Instituto Neurológico de Colombia were evaluated. The primary outcome was defined as complete improvement at 6 months. The Expanded Disability Status Scale (EDSS) score was calculated at baseline, nadir, discharge and follow up (6 months).
Results: A total of 88 attacks in 55 patients were included, 38 (69.1%) anti-aquaporine-4 positive. The median number of attacks was 2 (1-2). Thirty-eight (43.2%) patients had spinal cord attacks, followed by attacks in the optic nerve 28 (31.8%). Sixty-seven attacks [44 patients, 93.2% female, mean age at debut 43.9 (13.4) and median disease duration 5 years (3-8.5)] were treated with steroids alone. Nineteen attacks [9 patients, 88.9% female, mean age at debut 51 (11.7), and median disease duration 6 years (3-12)], were treated with PLEX (two attacks steroids and PLEX, one PLEX alone, and 16 PLEX after steroids). PLEX patients had a significantly higher EDSS at baseline (4.5 vs 1.0; p = 0.013), nadir (8.0 vs 5.0; p < 0.05) and at discharge (8.0 vs 5.0; p < 0.05). During the follow up 35% of the steroid treatment group while 47.1% of the PLEX group achieved a complete improvement (p= 0.61) with a delta EDSS of 1.0 at 6 months.
Conclusions: In this study there were no differences found when comparing the primary outcome in NMOSD patients according to the treatment with steroids versus PLEX. Both treatments can provide clinical improvement in acute relapses of NMOSD.
Disclosure: Lilliana M Giraldo: nothing to disclose
Angélica M Pino-Perez: nothing to disclose
Carolina Restrepo-Aristizabal: nothing to disclose
Felipe Alvarez-Gomez: nothing to disclose
Cesar A Franco: nothing to disclose
Jose Vladimir Tobon: nothing to disclose
Paula A Mazo: nothing to disclose
Jose Luis Ascencio: nothing to disclose
Maria I Zuluaga: nothing to disclose
Abstract: P974
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background: Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory disorders of the central nervous system characterized by acute attacks to the optic nerve and longitudinally extensive myelitis. In general, attacks are treated with high-dose intravenous glucocorticoids followed by plasma exchange (PLEX) in case of refractoriness. Recently, the possibility of starting with steroids associated to plasma exchange has been raised in order to impact on severe outbreaks.
Objective: To compare the outcome of relapses in patients with NMOSD treated with steroids versus PLEX.
Methods: A retrospective review of patients with NMOSD records was made. Data of all admissions to the Instituto Neurológico de Colombia were evaluated. The primary outcome was defined as complete improvement at 6 months. The Expanded Disability Status Scale (EDSS) score was calculated at baseline, nadir, discharge and follow up (6 months).
Results: A total of 88 attacks in 55 patients were included, 38 (69.1%) anti-aquaporine-4 positive. The median number of attacks was 2 (1-2). Thirty-eight (43.2%) patients had spinal cord attacks, followed by attacks in the optic nerve 28 (31.8%). Sixty-seven attacks [44 patients, 93.2% female, mean age at debut 43.9 (13.4) and median disease duration 5 years (3-8.5)] were treated with steroids alone. Nineteen attacks [9 patients, 88.9% female, mean age at debut 51 (11.7), and median disease duration 6 years (3-12)], were treated with PLEX (two attacks steroids and PLEX, one PLEX alone, and 16 PLEX after steroids). PLEX patients had a significantly higher EDSS at baseline (4.5 vs 1.0; p = 0.013), nadir (8.0 vs 5.0; p < 0.05) and at discharge (8.0 vs 5.0; p < 0.05). During the follow up 35% of the steroid treatment group while 47.1% of the PLEX group achieved a complete improvement (p= 0.61) with a delta EDSS of 1.0 at 6 months.
Conclusions: In this study there were no differences found when comparing the primary outcome in NMOSD patients according to the treatment with steroids versus PLEX. Both treatments can provide clinical improvement in acute relapses of NMOSD.
Disclosure: Lilliana M Giraldo: nothing to disclose
Angélica M Pino-Perez: nothing to disclose
Carolina Restrepo-Aristizabal: nothing to disclose
Felipe Alvarez-Gomez: nothing to disclose
Cesar A Franco: nothing to disclose
Jose Vladimir Tobon: nothing to disclose
Paula A Mazo: nothing to disclose
Jose Luis Ascencio: nothing to disclose
Maria I Zuluaga: nothing to disclose