{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:17:45Z","timestamp":1785889065232,"version":"3.56.0"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T00:00:00Z","timestamp":1572048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We evaluated therapeutic plasma exchange (TPE) efficiency in treatment of a single relapse in steroid\u2010refractory patients with neuromyelitis optica spectrum disorders (NMOSD) in a multi\u2010ethnic resource\u2010limited setting. This was a historical cohort study on the clinical outcomes post\u2010TPE in a multiethnic cohort of 53 steroid\u2010refractory NMOSD patients at a single Malaysian tertiary center. Primary outcomes, assessed both pre\u2010 and post\u2010TPE, were Medical Research Council scale of muscle power, Modified Rankin Scale, Expanded Disability Status Scale (EDSS), and visual acuity. Secondary outcomes were ambulatory status and target neurological deficit (TND)\u2010based TPE response. Significant improvements in Medical Research Council, Modified Rankin Scale, EDSS, and visual acuity (<jats:italic>P<\/jats:italic> &lt;\u20090.001) were observed at 1\u2010month post\u2010TPE with further improvement of EDSS at 6\u2009months (EDSS\u03946) post\u2010TPE (<jats:italic>P<\/jats:italic> &lt;\u20090.001). At 6\u2009months post\u2010TPE, 87% of patients has successful TND\u2010based TPE response and 69.8% were ambulating without support. Patients with anti\u2010aquaporin 4 seronegativity (<jats:italic>P<\/jats:italic> =\u20090.004), myelitis and brainstem features at first relapse (<jats:italic>P<\/jats:italic> =\u20090.004), longer cord lesions (<jats:italic>P<\/jats:italic> =\u20090.030), higher pre\u2010TPE EDSS of \u22658 (<jats:italic>P<\/jats:italic> =\u20090.018) and delayed TPE initiation of &gt;14\u2009days (<jats:italic>P<\/jats:italic> =\u20090.047) were significantly associated with improved EDSS\u03946. TND\u2010based TPE response was significant in absence of cord atrophy (<jats:italic>P<\/jats:italic> =\u20090.030). TPE is an effective treatment for steroid\u2010refractory acute relapses of NMOSD in a multiethnic Malaysian population despite its resource\u2010limited setting. The predictive factors of EDSS\u03946 improvement were anti\u2010aquaporin 4 seronegativity, longer cord lesions, and higher pre\u2010TPE EDSS. Absence of cord atrophy was predictive of better TND\u2010based TPE response. Unexpectedly, our study showed that delayed TPE initiation of more than 14\u2009days and up to 60\u2009days may also be beneficial.<\/jats:p>","DOI":"10.1111\/1744-9987.13446","type":"journal-article","created":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T13:09:41Z","timestamp":1572095381000},"page":"312-323","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Therapeutic Plasma Exchange in Neuromyelitis Optica Spectrum Disorders and Related Disorders in Resource\u2010Limited Settings: Outcomes in a Multiethnic Single\u2010Center Population"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8224-6922","authenticated-orcid":false,"given":"Zhi Miin","family":"Ong","sequence":"first","affiliation":[{"name":"Department of Neurology Kuala Lumpur Hospital, Ministry of Health  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie Ping","family":"Schee","sequence":"additional","affiliation":[{"name":"Department of Neurology Kuala Lumpur Hospital, Ministry of Health  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanthi","family":"Viswanathan","sequence":"additional","affiliation":[{"name":"Department of Neurology Kuala Lumpur Hospital, Ministry of Health  Kuala Lumpur 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