MS Relapse – PLEX for Steroid Intolerance — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS Relapse – PLEX for Steroid IntoleranceSCE Neurology

A 45-year-old woman with MS has an acute relapse causing right optic neuritis (VA 6/60). She cannot tolerate IV or oral methylprednisolone (severe GI side effects). What alternative relapse treatment can be offered?

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Correct answer: D — Plasma exchange (PLEX) — may be offered for steroid-intolerant or steroid-refractory MS relapses

For patients who cannot tolerate corticosteroids (or have steroid-refractory relapses), plasma exchange (PLEX) is the recommended alternative. PLEX directly removes circulating antibodies and complement components contributing to the acute inflammatory demyelinating process. Evidence supports its use particularly for severe relapses affecting the optic nerve and spinal cord. A: PLEX is available. C: Low-dose prednisolone is inadequate. D: IVIg has limited evidence for MS relapses. E: Rituximab is preventive, not for acute relapses.

Reference: NICE NG100 MS; ABN MS Guidelines (2022)