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MS PLEX – Regimen — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS PLEX – RegimenSCE Neurology

A patient with AQP4-IgG-positive NMOSD develops severe longitudinally extensive transverse myelitis. After 3 days of intravenous methylprednisolone 1 g/day, paraplegia and a sensory level remain unchanged. What is the most appropriate escalation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Begin early plasma exchange or immunoadsorption for rescue

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

A delays an outcome-sensitive rescue treatment. B can worsen AQP4-positive NMOSD and is not acute rescue. C is correct: severe attacks with insufficient response in the first days should proceed early to apheresis; five to seven exchanges are commonly used. D is neither first rescue nor timely. E treats a symptom while allowing inflammatory spinal-cord injury to continue.

Reference: NEMOS revised recommendations: NMOSD attack therapy: https://pmc.ncbi.nlm.nih.gov/articles/PMC10770020/