Abstract
Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination.
Highlights
Called cascade double filtration plasmapheresis (DFPP), is a two-step filtration-based procedure that semi-selectively eliminates the immune-relevant elements from plasma using an advanced system of filters disposed in parallel [1]
A 250 mL aliquot of 5% human albumin solution is the unique supplementation required during each session of DFPP, as compared to plasma exchange (PEX) which requires total plasma replacement, and provides better safety, fewer side effects, and comparable results [1,3]
We report the case of a 37-year-old woman affected by relapsing remitting multiple sclerosis (MS) (RRMS) with disease onset at 28 years with left retrobulbar optic neuritis (RBON) and pyramidal involvement as detected by prevalent tendon reflexes at the right limbs and the ipsilateral Barre’s sign
Summary
Called cascade double filtration plasmapheresis (DFPP), is a two-step filtration-based procedure that semi-selectively eliminates the immune-relevant elements from plasma using an advanced system of filters disposed in parallel [1]. Relapsed MS is thought to be a type II Lucchinetti pathological pattern, expressing the main inflammation through antibodies/plasma cells and their complements. This could be the probable explanation for why relapsed MS and the retrobulbar optic neuritis (RBON) have a good response to PEX [8,9,10] and DFPP [3]. MS relapse during the wash-out period from Fingolimod (FTY) The discontinuation of the latter can induce in some individuals a disease rebound sustained by the cleanable humoral factors of the neuroinflammation [11,12,13,14,15]. Fingolimod treatment and the biological mechanisms involved in its sensitivity to DFPP
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
