American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment may be considered for multiple sclerosis relapses that do not respond to glucocorticoids?

1. Intravenous immunoglobulin

2. Rescue therapy with plasmapheresis

3. High-dose oral steroids

4. Neuromodulatory agents

The correct answer is: Rescue therapy with plasmapheresis

When considering treatments for multiple sclerosis relapses that do not respond to glucocorticoids, plasmapheresis can be an effective option. Plasmapheresis, or therapeutic plasma exchange, involves the removal of plasma from the blood and is used to reduce the levels of circulating inflammatory mediators, including antibodies that may exacerbate the symptoms of a relapse. This procedure can help diminish the severity and duration of the relapse when standard treatments, such as high-dose glucocorticoids, are ineffective. In situations where glucocorticoids do not lead to improvement, plasmapheresis can offer benefits by providing a more aggressive and direct means of intervention against the autoimmune aspects of multiple sclerosis. This treatment is particularly considered for severe exacerbations where prompt recovery is crucial for the patient's well-being and function. Other treatment options listed may have roles in managing multiple sclerosis but do not exhibit the same level of efficacy as plasmapheresis specifically for refractory relapses. Therefore, in cases where glucocorticoids fail to induce a response, resorting to plasmapheresis represents a robust alternative worth considering.