Abstract
Background
Therapeutic plasma exchange (TPE) is an extracorporeal treatment that can be used
in adult and pediatric patients with acute demyelinating syndromes of the central
nervous system. In this study, the efficacy and safety of TPE was evaluated in 10
pediatric patients who underwent TPE that were unresponsive to corticosteroid treatment.
Methods
Records of 10 pediatric patients who underwent TPE in our pediatric intensive care
unit (PICU) between May 2017 and June 2020 were used. Expanded Disability Status Scale
(EDSS), Gait Scale (GS), and Visual Outcome Scale (VOS) were applied to the patients
before and after TPE.
Results
Of the 10 patients who underwent TPE, five were diagnosed with multiple sclerosis
(MS), three with transverse myelitis (TM), and two with acute disseminated encephalomyelitis
(ADEM). The median age of the patients was 13.3 years (IQR 8-15), and the median day
from symptom onset to onset of TPE was 12.5 days (IQR 7-28). A total of 104 TPE sessions
were performed successfully. While no complications were encountered in three patients
during the sessions, the most common complication was hypofibrinogenemia. The decrease
in EDSS and GS scores was found to be consistent with the clinical response of the
patients. There was no statistically significant decrease in the VOS.
Conclusions
With this study, we can say that TPE is a feasible, effective, and safe treatment
modality in children with acute demyelinating syndromes of the central nervous system.
Keywords
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References
- Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis.Neurotherapeutics. 2016; 13: 84-95
- Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue.J Clin Apher. 2019; 34: 171-354
- A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease.Ann Neurol. 1999; 46: 878-886
- Therapeutic plasma exchange in children with acute autoimmune central nervous system disorders.Int J Artif Organs. 2015; 38: 494-500
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- The clinical course of neuromyelitis optica (Devic's syndrome).Neurology. 1999; 53: 1107-1114
- International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions.Mult Scler. 2013; 19: 1261-1267
- Overview of therapeutic plasma exchange in pediatric neurology: a single-center experience.Acta Neurol Belg. 2018; 118: 451-458
- N-methyl-D-aspartate receptor antibody-mediated neurological disease: results of a UK-based surveillance study in children.Arch Dis Child. 2015; 100: 521-526
- Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study.Lancet Neurol. 2013; 12: 157-165
- Outcomes after early administration of plasma exchange in pediatric central nervous system inflammatory demyelination.J Child Neurol. 2015; 30: 874-880
- Prognostic indicators of improvement with therapeutic plasma exchange in pediatric demyelination.Neurology. 2019; 93: e2065-e2073
- Safety and efficacy of plasma exchange in pediatric transverse myelitis.Neurol Clin Pract. 2018; 8: 327-330
- Plasma exchange for severe attacks of CNS demyelination: predictors of response.Neurology. 2002; 58: 143-146
- A retrospective cohort study of plasma exchange in central nervous system demyelinating events in children.Mult Scler Relat Disord. 2019; 35: 50-54
- Safety and efficacy of plasma exchange for the treatment of optic neuritis in neuromyelitis optica spectrum disorders: A protocol for systematic review and meta-analysis.Medicine ((Baltimore)). 2020; 99e21067
- Therapeutic plasma exchange in children: One center's experience.J Clin Apher. 2017; 32: 494-500
- Pediatric Therapeutic Apheresis: A Critical Appraisal of Evidence.Transfus Med Rev. 2016; 30: 217-222
- Feasibility of pediatric plasma apheresis in intensive care settings.Ther Apher Dial. 2014; 18: 497-501
- Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm.Dev Med Child Neurol. 2018; 60: 765-779
- Plasmapheresis in neurological disorders: Experience from a tertiary care hospital in South India.Ann Indian Acad Neurol. 2015; 18: 15-19
- Anticoagulation options for pediatric hemodialysis.Hemodial Int. 2003; 7: 168-176
Article info
Publication history
Published online: March 14, 2022
Accepted:
March 6,
2022
Received in revised form:
February 27,
2022
Received:
January 6,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
