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Therapeutic plasma exchange in pediatric patients with acute demyelinating syndromes of the central nervous system: A single-center experience

  • Author Footnotes
    1 ORCID: 0000–0002-8273–2226
    Nihal Akcay
    Correspondence
    Correspondence to: University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba distinct, Dr. Tevfik Saglam street, No: 11, Bakirkoy, Istanbul, Turkey.
    Footnotes
    1 ORCID: 0000–0002-8273–2226
    Affiliations
    Pediatric Intensivist, Pediatric Intensive Care, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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  • Author Footnotes
    2 ORCID: 0000–0001-7445–5858
    Ulkem Kocoglu Barlas
    Footnotes
    2 ORCID: 0000–0001-7445–5858
    Affiliations
    Pediatric Intensivist, Pediatric Intensive Care, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
    Search for articles by this author
  • Author Footnotes
    3 ORCID: 0000–0002-6725–3964
    Gonca Bektas
    Footnotes
    3 ORCID: 0000–0002-6725–3964
    Affiliations
    Pediatric Neurology, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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  • Author Footnotes
    4 ORCID: 0000–0003-0120–8711
    Hasan Serdar Kihtir
    Footnotes
    4 ORCID: 0000–0003-0120–8711
    Affiliations
    Pediatric Intensivist, Pediatric Intensive Care, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
    Search for articles by this author
  • Author Footnotes
    5 ORCID: 0000–0002-8330–2877
    Esra Sevketoglu
    Footnotes
    5 ORCID: 0000–0002-8330–2877
    Affiliations
    Pediatric Intensivist, Chief of the Pediatric Intensive Care Unit, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
    Search for articles by this author
  • Author Footnotes
    1 ORCID: 0000–0002-8273–2226
    2 ORCID: 0000–0001-7445–5858
    3 ORCID: 0000–0002-6725–3964
    4 ORCID: 0000–0003-0120–8711
    5 ORCID: 0000–0002-8330–2877

      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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