Effect of Various Plasmapheresis Therapies for Seronegative Neuromyelitis Optica

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  • Seshima,Hiroshi
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Ohkubo,Atsushi
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Itagaki,Ayako
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Maeda,Takuma
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Arai,Shingo
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Miyamoto,Satoko
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Kurashima,Naoki
    Medical Engineering Center, Medical Hospital of Tokyo Medical and Dental University
  • Iimori,Soichiro
    Department of Nephrology, Tokyo Medical and Dental University
  • Naito,Syotaro
    Department of Nephrology, Tokyo Medical and Dental University
  • Okado,Tomokazu
    Department of Nephrology, Tokyo Medical and Dental University
  • Rai,Tatemitsu
    Department of Nephrology, Tokyo Medical and Dental University

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Other Title
  • 抗AQP4抗体陰性視神経脊髄炎に対するアフェレシス療法の効果

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Description

A patient with seronegative neuromyelitis optica was treated with three different modalities of plasmapheresis: plasma exchange (PE), selective plasma exchange (SePE), and immunoadsorption plasmapheresis (IAPP). We investigated the improvement of grip strength and manual muscle testing (MMT), and the removal ratio of immunoglobulin G (IgG) and fibrinogen (Fbg) by each modality. The mean percent reductions of IgG and Fib by PE, SePE and IAPP were as follows: IgG: 67.1%, 58.1% and 38.2% and Fbg: 68.8%, 24.3% and 51.7%, respectively. Grip strengths and all components of MMT were improved by both PE and SePE. However, worsening of several components of MMT was observed for IAPP. The bleeding tendency seen after six sessions of PE was improved by changing the therapy to a combination of PE and SePE. Removal of IgG contributed to the improvement of symptoms and the bleeding complication was presumably caused by the removal of coagulation factors. Compared with IAPP, PE can be considered to be a more appropriate plasmapheresis therapy for the present case. It is important to select the appropriate plasmapheresis modality such as the combination therapy of PE and SePE on the basis of maintenance of coagulation factors.

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