Therapeutic Plasma Exchange in Neuromyelitis Optica Spectrum Disorder: Real‐World Clinical Outcomes and Safety From a Tertiary Care Center in Northwest India
Alka Kumari, Sarita Sharma, Ajay Kumar, Sunita BundasABSTRACT
Background and Objectives
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a severe autoimmune demyelinating disorder of the central nervous system characterized by relapsing attacks that can result in permanent neurological disability. Therapeutic Plasma Exchange (TPE) is recommended for steroid‐refractory acute exacerbations. This study evaluated the efficacy and safety of TPE in patients with acute NMOSD attacks.
Materials and Methods
A prospective observational study was conducted over 18 months at SMS Jaipur, India. Forty adult patients fulfilling the 2015 International Panel for NMO Diagnosis criteria and presenting with steroid‐refractory acute attacks were enrolled. TPE was performed using continuous‐flow centrifugation, exchanging 1.0–1.4 estimated plasma volumes per session for 3–7 alternate‐day procedures. Clinical outcomes were assessed using the EDSS, Snellen visual acuity, and MRC muscle strength grading.
Results
The cohort had a female predominance (65.0%) with a mean age of 36.5 years. Acute first presentations accounted for 77.5% of cases, while 22.5% were relapses. Anti‐aquaporin‐4 antibody positivity was detected in 45.0% of patients. Among 37 patients with motor deficits, 94.6% showed clinical improvement following TPE, including marked (35.1%), moderate (43.2%), and mild (16.2%) responses. Mean EDSS improved significantly from 7.4 to 4.1 (95% CI and p < 0.001). Visual improvement was observed in 84.4% of patients with baseline visual impairment. Adverse events occurred in 25.0% of patients, predominantly transient hypotension and mild citrate‐related hypocalcemia, with no procedure‐related treatment discontinuation.
Conclusion
TPE is a safe and effective rescue therapy for steroid‐refractory NMOSD exacerbations, producing substantial neurological and visual recovery with a favorable safety profile.