Plasma exchange in neurology patients-experience from single center in Montenegro

INTRODUCTION

Plasma exchange (PE) is widely used in many immune-based neurological diseases. Our aim is to analyze characteristics of PE in neurological patients at the Clinical Center of Montenegro.

METHODS

Our study involved neurological patients treated with PE between January 2020 and April 2022.

RESULTS

In total, 246 PEs were performed in 43 patients. We divided patients into 4 groups according to indications. In 8/9 multiple sclerosis (MS) patients a decrease of Expanded Dysability Status Scale at least 0.5 was verified. In 14/20 Guillain Barre syndrome patients reduction of Hughes was observed. Four patients with myasthenia gravis (MG) were treated with PE. The most heterogeneous group (4) consisted of patients in whom the mechanism of disease development is assumed to be immune system dysregulation. Fourteen patients had any adverse event.

CONCLUSION

Our results show that PE is widely used and safe in the treatment of neurological diseases.

Reorganization of multiple sclerosis health care system in Clinical Centre of Montenegro during the COVID-19 pandemic

The COVID-19 epidemic has brought a number of changes to health systems, including the provision of health services to patients with multiple sclerosis (MS). Work in the Clinic for Neurology of the Clinical Center of Montenegro (CN-CCM) with MS patients continued as much as possible during the epidemic. The administration of the already started disease-modifying therapy (DMT) continued, and the introduction of the new one was postponed until the moment when the epidemic started to slow down. During the epidemic period, plasmapheresis treatment was performed in CN-CCM without any complications. New ways of communications (special e-mail address and phone line) with MS patients during epidemic were realized. During epidemic, smaller number of relapses were reported compared to same period in 2019. There were not MS patients in Montenegro suffering from SARS-Cov2 virus infection.

The correlation between the level of 25-hydroxyvitamin D [25(OH)D] and residency of multiple sclerosis patients in Montenegro – higher levels only in men in the north of the country

Background/Aim. Multiple Sclerosis (MS) is a chronic neurological disease associated with low serum levels of 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to determine the association between serum levels of 25(OH)D and the latitude as well as clinical MS severity and progression expressed by expanded disability status scale (EDSS) and multiple sclerosis severity score (MSSS). Methods. A total of 196 patients, from North and South of Montenegro, aged 18 to 65 years, with confirmed diagnosis of MS were recruited for the study. Serum samples were collected for 25(OH)D measurement. Control group consisted of 196 health controls, randomly selected from medical staff employed in health centers from three cities in North and Clinical Centre of Montenegro from the South. Results. The serum levels of 25(OH)D were significantly lower in MS patients compared to controls (p < 0.001). The serum levels of 25(OH)D were significantly different in regard to gender, with women showing lower levels. Although in the entire group of patients there was no statistical correlation between the levels of 25(OH)D and their residence, the significantly higher levels of 25(OH)D were detected in men from the North compared to women. The course of the disease had an impact on the 25(OH)D serum levels. 25(OH)D levels also significantly correlated with clinical parameters of both, disability (Spearman''s r = -0.23, p = 0.001) and progression (Spearman''s r = -0.25, p = 0.0004) of MS. Conclusion. Serum levels of 25(OH)D were associated with disability and progression in MS patients. Lower levels of 25(OH)D were detected in female patients from the North. The low level of 25(OH)D cannot be solely explained with unfavorable latitude and insufficient sun exposure, therefore further genetic analysis is needed.