If disabling MS relapses insufficiently respond to steroid treatment, TPE is recommended as a second-line treatment option. About 70% of these cases show a clinical improvement to TPE. Knowledge about features which predict the response to TPE is poor.

We retrospectively reviewed CIS and MS patients who were treated with TPE in our clinic since 2005. Data regarding disease-modifying treatment, disease and symptom duration, cerebrospinal fluid and MRI parameters, EDSS, treatment with steroids, number of TPE sessions and number of affected functional systems were analysed.

N=72 CIS and MS patients (53 women and 19 men) were included. The median age was 39 years (range 17-67 years). A number of 45 patients (62.5%) experienced a clinical improvement after TPE. In comparison with non-responders TPE responders showed a higher M:F-ratio (1:2.5 vs 1:3.5), a higher number of TPE sessions (5.8 ± 2.2 vs 5.2 ± 1.1), a lower disease duration (67.0 ± 79.8 vs 97.4 ± 103.0 months), a lower symptom duration (9.9 ± 9.6 vs 12.4 ± 8.4 weeks), a higher number of affected functional symptoms (2.1 ± 1.1 vs 1.6 ± 0.8), a higher EDSS score during the relapse (4.7 ± 1.6 vs 3.7 ± 1.6) and a higher number of CSF oligoclonal bands (9.3 ± 6.7 vs 8.2 ± 5.9).

Both clinical and cerebrospinal fluid features seem to predict whether CIS or MS patients respond to TPE. Especially male gender, a sufficient number of TPE sessions, a low disease and symptom duration, multifocal symptoms, a high EDSS increase as well as a higher number of CSF oligoclonal bands are related to TPE efficacy.