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Plasma exchange (PLEX) is used for patients with severe multiple sclerosis (MS) relapses refractory to glucocorticoids. The mechanism of action is imperfectly known but thought to include clearance of immunoglobulins, immune complexes, and complement. These investigators assessed the relation between clinical responsiveness to PLEX and three patterns of histologic features seen on brain biopsy in 69 MS patients with demyelinating lesions. Pattern 1 (a T-lymphocyte- and macrophage-dominated inflammatory picture) was observed in 23% of patients. Prominent deposition of immunoglobulin and complement was the hallmark of pattern 2, observed in 58%. Pattern 3, observed in 19%, was associated with loss of oligodendrocytes. No clear differences in …