{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:35:51Z","timestamp":1791304551988,"version":"4.3.1"},"reference-count":41,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Severe attacks of neuromyelitis optica spectrum disorder (NMO-SD) are improved by plasma exchange (PLEX) given as an adjunctive therapy. Initial studies failed to demonstrate a delay of PLEX treatment influenced clinical outcome; however PLEX was always used late. We examine the clinical consequences of delay in PLEX initiation on severe optic neuritis and spinal cord attacks in NMO-SD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All of our patients who suffered attacks of NMO-SD, treated in our centre by PLEX, were retrospectively considered for inclusion. Primary outcome was defined as complete improvement. Secondary poor\/good outcomes were respectively defined to be the higher\/lower third of Delta-Expanded Disability Status Scale (EDSS) (late minus baseline EDSS). Delays from clinical onset to PLEX initiation were categorised for multivariate analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 60 patients included, NMO-SD criteria (2015) were fulfilled in 92%. One hundred and fifteen attacks were included and received PLEX with a median of 7 days (0\u201354) after clinical onset. The probability to regain complete improvement continuously decreased from 50% for PLEX given at day 0 to 1%\u20135% after day 20. Through multivariate analysis, the baseline impairment and PLEX delay were associated with the probability to complete improvement (OR 5.3; 95%\u2009CI 1.8 to 15.9). Reducing the PLEX delay also influenced the good secondary outcome but not the poor secondary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results confirm an improved clinical benefit of early initiation of PLEX during severe attacks of NMO-SD. Perceiving PLEX as a rescue therapy only after steroid failure could be deleterious.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2017-316286","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T20:55:13Z","timestamp":1507928113000},"page":"346-351","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":313,"title":["Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders"],"prefix":"10.1136","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1401-3921","authenticated-orcid":false,"given":"Mickael","family":"Bonnan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudy","family":"Valentino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Debeugny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold","family":"Merle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"Ferg\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Mehdaoui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Cabre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,10,13]]},"reference":[{"key":"2020050722293202000_89.4.346.1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.5.1107"},{"key":"2020050722293202000_89.4.346.2","doi-asserted-by":"publisher","DOI":"10.1590\/0004-282X20130020"},{"key":"2020050722293202000_89.4.346.3","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12629"},{"key":"2020050722293202000_89.4.346.4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/CND.0b013e31822c34dd","article-title":"Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study","volume":"13","author":"Heatwole","year":"2011","journal-title":"J Clin Neuromuscul Dis"},{"key":"2020050722293202000_89.4.346.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2010.05.030"},{"key":"2020050722293202000_89.4.346.6","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11940-015-0378-x","article-title":"Acute and Chronic Management of Neuromyelitis Optica Spectrum Disorder","volume":"17","author":"Sherman","year":"2015","journal-title":"Curr Treat Options Neurol"},{"key":"2020050722293202000_89.4.346.7","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-Q"},{"key":"2020050722293202000_89.4.346.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2013.02.027"},{"key":"2020050722293202000_89.4.346.9","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.34"},{"key":"2020050722293202000_89.4.346.10","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2013.9.1.36"},{"key":"2020050722293202000_89.4.346.11","doi-asserted-by":"publisher","DOI":"10.1177\/1352458512471875"},{"key":"2020050722293202000_89.4.346.12","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/j.lpm.2010.11.022","article-title":"[Plasma exchanges in severe and acute inflammatory demyelinating attacks of the central nervous system]","volume":"40","author":"Brunot","year":"2011","journal-title":"Presse Med"},{"key":"2020050722293202000_89.4.346.13","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b879be"},{"key":"2020050722293202000_89.4.346.14","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.58.1.143"},{"key":"2020050722293202000_89.4.346.15","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001729"},{"key":"2020050722293202000_89.4.346.16","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318296e917"},{"key":"2020050722293202000_89.4.346.17","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.05-0981"},{"key":"2020050722293202000_89.4.346.18","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3928\/1081-597X-19970701-16","article-title":"Proper method for calculating average visual acuity","volume":"13","author":"Holladay","year":"1997","journal-title":"J Refract Surg"},{"key":"2020050722293202000_89.4.346.19","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2009.175"},{"key":"2020050722293202000_89.4.346.20","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.65.11.noc80069"},{"key":"2020050722293202000_89.4.346.21","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2012-303121"},{"key":"2020050722293202000_89.4.346.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.06.060"},{"key":"2020050722293202000_89.4.346.23","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.143529"},{"key":"2020050722293202000_89.4.346.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67102-4"},{"key":"2020050722293202000_89.4.346.25","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf151"},{"key":"2020050722293202000_89.4.346.26","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000289761.64862.ce"},{"key":"2020050722293202000_89.4.346.27","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1109980108"},{"key":"2020050722293202000_89.4.346.28","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s00401-013-1204-8","article-title":"Unique neuromyelitis optica pathology produced in na\u00efve rats by intracerebral administration of NMO-IgG","volume":"127","author":"Asavapanumas","year":"2014","journal-title":"Acta Neuropathol"},{"key":"2020050722293202000_89.4.346.29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/787630","article-title":"Plasma exchange in severe attacks of neuromyelitis optica","volume":"2012","author":"Bonnan","year":"2012","journal-title":"Mult Scler Int"},{"key":"2020050722293202000_89.4.346.30","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-010-1344-7"},{"key":"2020050722293202000_89.4.346.31","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515581438"},{"key":"2020050722293202000_89.4.346.32","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.neurol.2008.08.005","article-title":"[Severe bouts of neuromyelitis optica: dramatic improvement after plasma exchanges]","volume":"165","author":"Bonnan","year":"2009","journal-title":"Rev Neurol"},{"key":"2020050722293202000_89.4.346.33","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24554"},{"key":"2020050722293202000_89.4.346.34","doi-asserted-by":"publisher","DOI":"10.1177\/1352458508100837"},{"key":"2020050722293202000_89.4.346.35","first-page":"1","article-title":"Improvement to baseline after plasma exchange in spinal attacks associated with neuromyelitis optica","volume":"1","author":"Bonnan","year":"2015","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"2020050722293202000_89.4.346.36","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/jca.21339","article-title":"The top clinical trial opportunities in therapeutic apheresis and neurology","volume":"29","author":"Morgan","year":"2014","journal-title":"J Clin Apher"},{"key":"2020050722293202000_89.4.346.37","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.expneurol.2014.03.004","article-title":"Human immunoglobulin G reduces the pathogenicity of aquaporin-4 autoantibodies in neuromyelitis optica","volume":"255","author":"Ratelade","year":"2014","journal-title":"Exp Neurol"},{"key":"2020050722293202000_89.4.346.38","doi-asserted-by":"publisher","DOI":"10.1177\/1352458506071174"},{"key":"2020050722293202000_89.4.346.39","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2012.1126"},{"key":"2020050722293202000_89.4.346.40","first-page":"402","article-title":"Removal of prednisone and prednisolone by plasma exchange","volume":"3","author":"Stigelman","year":"1984","journal-title":"Clin Pharm"},{"issue":"Suppl 1","key":"2020050722293202000_89.4.346.41","first-page":"38","article-title":"[Removal of prednisone and prednisolone during plasma exchange]","volume":"139","author":"Assogba","year":"1988","journal-title":"Ann Med Interne"}],"container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnnp-2017-316286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T12:20:15Z","timestamp":1659615615000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnnp.bmj.com\/lookup\/doi\/10.1136\/jnnp-2017-316286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,13]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,3,15]]},"published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1136\/jnnp-2017-316286"],"URL":"https:\/\/doi.org\/10.1136\/jnnp-2017-316286","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.731998174.793549359","asserted-by":"object"},{"id-type":"doi","id":"10.3410\/f.731998174.793546722","asserted-by":"object"}]},"ISSN":["0022-3050","1468-330X"],"issn-type":[{"value":"0022-3050","type":"print"},{"value":"1468-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,13]]}}}