Primary Objective

 To assess response to Therapeutic plasma exchange (TPE) in acute relapses of various CNS demyelinating disorders using disease specific outcome scores at specified time-periods. 

Secondary objectives. 

 To assess the outcome of Early v/s Late Plasma Exchange in Acute Relapses of CNS demyelinating disorders in patients who have failed pulse steroids.

To analyse clinical characteristics of patients having a favourable response to Plasma Exchange.

To observe complications if any of the TPE procedure.

Relapses of Central Nervous System (CNS) demyelinating disorders can have a suboptimal response to steroids and are known as steroid refractory relapses. The second line agents used include TPE and intravenous immunoglobulin (IVIG). This ambispective cohort study looks at the response rates and optimal duration of TPE in steroid refractory relapses.

All patients diagnosed with a relapse of CNS demyelinating disorder requiring TPE as per discretion of the treating neurologist and admitted in Neurology wards were included in the study. Baseline characteristics were taken, and disease specific baseline outcome scales were used. All patients were followed up immediately after completion of all cycles of PLEX and then at day 30 and three months post TPE.

A total of 124 patients were recruited in the study between Jan 2019 and July 2023. MOGAD was the most frequent CNS demyelination (31%) in the present cohort of patients. The primary outcome occurred in 94/124 (75.8%) patients undergoing PLEX with significant inverse correlation between age, duration between start of steroids and plasmapheresis. The rate of complications was 8.9% with one mortality. Early plasmapheresis (<2 weeks) was associated with a favourable outcome.

Plasmapheresis is a safe and effective therapeutic option in patients of CNS demyelinating disorders with high response rates in selected cases and should be offered early within two weeks of the onset of the disease to prevent disability.