Therapeutic Effect of Plasma Exchange (PLEX) in Neuromyelitis Optica (NMO): Immediate and Long Term Response (S63.005)
Bibliographic record
Abstract
OBJECTIVE: To study the immediate and long term therapeutic effect of plasma exchange in patients with NMO BACKGROUND: The natural course of NMO is significantly worse compared to other CNS demyelinating diseases. Appropriate management of attacks and maintenance treatment are considered very crucial. High dose steroid is commonly used as first-line treatment for attacks. Sometimes severe attacks may not respond or progress despite this treatment. PLEX is used as rescue therapy in these cases. Most of available data on the effect of PLEX in steroid-refractory attacks are either small case-series or are part of cohort of patients with other CNS demyelinating diseases. DESIGN/METHODS: 36 eligible patients with NMO or NMO spectrum disorders (modified diagnostic criteria, Wingerchuck et al, 2006) were identified by retrospective chart review. One plasma volume exchange with 5% albumin replacement, was given for 5-7 treatments, usually on alternating days. We studied clinical improvement at time of discharge and long term (6 month and 1 year). Clinical improvement was evaluated in two distinct ways by using ordinal scales; 1) Overall functional improvement, 2) Improvement in neurological systems (sensory, motor and vision). Possible determinants of favorable response were examined. RESULTS: Our preliminary data shows that patients with positive NMO serology have fewer relapses after plasma exchange compared to NMO negative patients. 60% of patients showed mild or moderate functional improvement at time of discharge. Significant improvement in overall function was associated with brisk/preserved reflexes and positive NMO serology. Motor and sensory improvement at the time of discharge was noted in 38% and 34% of patients respectively. Both of these measures were associated with brisk/preserved reflexes. Furthermore, younger patients showed better recovery in their sensory deficits at time of discharge. CONCLUSIONS: Plasma exchange is a modestly beneficial rescue therapy for acute, steroid-refractory attacks of NMO. Our preliminary data suggests some clinical and serological features that may help to predict more favorable outcome after PLEX. Study Supported by:
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".