A Case Report of Plasmapheresis in the Treatment of Acute Disseminated Encephalomyelitis

Abstract

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system associated with significant morbidity and mortality. High-dose corticosteroid administration has been considered the mainstay of treatment for ADEM; however, some patients with ADEM are refractory to steroid therapy. We report a case of a 17-year-old man suffering from ADEM who did not respond to corticosteroid therapy, but who exhibited a dramatic recovery with plasmapheresis. He became comatose, requiring ventilatory support, and exhibited abnormalities of some brainstem reflexes prior to treatment. He underwent sequential courses of plasma exchange therapy for three days. Plasma exchanges were carried out with concomitant continuous hemodiafiltration (CHDF) to control intracranial pressure by stabilizing pH, plasma Na+ concentration, and colloid osmotic pressure. After plasma exchanges, his reflexes and level of consciousness gradually improved. Eleven months after this treatment, he had only minimal neurological deficit that did not interfere with any of his activities of daily living. The efficacy of plasmapheresis for ADEM has not yet been established. Plasmapheresis may be indicated for ADEM, not only for patients with severe disease in whom high-dose corticosteroid treatment has failed, but also as first-line treatment for ADEM. Early initiation of plasmapheresis appears to be associated with moderate to marked improvement. Early recognition and early treatment of ADEM are thus of paramount importance.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

“…The serum ferritin was reduced from 1517 ± 1329 ng/mL to 20 ± 6.5 ng/mL after 6.7 ± 2.9 months and 13.5 ± 7.2 apheresis sessions. A similar protocol was used in a pilot study from the Netherlands in which six patients achieved iron depletion with erythrocytapheresis in a mean [range]) of 9.8 procedures over 4.8 months, compared to 32 procedures over 15.5 months required for phlebotomy among six historical control patients. A follow‐up prospective, randomized trial by this same group compared erythrocytapheresis of 350–800 mL of erythrocytes every 2 weeks to a minimum post procedure Hct of ≥30% with weekly phlebotomy of 500 mL among 38 patients with newly diagnosed C282Y‐positive hereditary hemochromatosis.…”

Acute disseminated encephalomyelitis due to abrus precatorius poisoning – A case report

“…Hence the patient underwent plasmapheresis and her symptoms resolved after six sessions of plasmapheresis. Plasmapheresis helps in reversing the neuropathological process involved in demyelination (Shinozaki et al, 2008). It is also used in the management of autoimmune diseases like Myasthenia gravis, Guillain-Barre syndrome, Lamber-Eaton myasthenic syndrome and also in poisoning cases (Dyck et al, 1985).…”

Akut Dissemine Ensefalomiyelitli Vakanın Çift Filtrasyon Plazmaferez ile Tedavisi

“…Bu olgu sunumunda yüksek doz İVMP tedavisine dirençli hastada ÇFP tedavisinin etkinliğini gösterdik. Literatürde ADEM'de terapötik plazmaferez tekniklerinden biri olan DPD gösterilmiştir (16). MS'in akut epizodunda ÇFP tedavisi uygulanmıştır (12).…”