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Multiple Sclerosis International
Volume 2012, Article ID 787630, 9 pages
Review Article

Plasma Exchange in Severe Attacks of Neuromyelitis Optica

1Service de Neurologie, Hopital F. Mitterand, 64000 Pau, France
2Service de Neurologie, Hôpital Zobda Quitman, 97261 Fort de France, Martinique

Received 13 September 2011; Revised 13 November 2011; Accepted 17 November 2011

Academic Editor: Jerome de Seze

Copyright © 2012 Mickael Bonnan and Philippe Cabre. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Neuromyelitis optica (NMO) attacks are poorly controlled by steroids and evolve in stepwise neurological impairments. Assuming the strong humoral response underlying NMO attacks, plasma exchange (PLEX) is an appropriate technique in severe NMO attacks. Objective. Presenting an up-to-date review of the literature of PLEX in NMO. Methods. We summarize the rationale of PLEX in relation with the physiology of NMO, the main technical aspects, and the available studies. Results. PLEX in severe attacks from myelitis or optic neuritis are associated with a better outcome, depending on PLEX delay (“time is cord and eyes”). NMO-IgG status has no influence. Finally, we build up an original concept linking the inner dynamic of the lesion, the timing of PLEX onset and the expected clinical results. Conclusion. PLEX is a safe and efficient add-on therapy in NMO, in synergy with steroids. Large therapeutic trials are required to definitely assess the procedure and define the time opportunity window.