Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

Eyre, Michael; Hacohen, Yael; Barton, Carmen; Hemingway, Cheryl; Lim, Ming

doi:10.1111/dmcn.13925

Cited by 31 publications

(37 citation statements)

References 89 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, the multiple effects of TPE and its ancillary anticoagulants and blood products on the patient, including fairly predictable derangements of electrolytes and depletion of haemoglobin, platelets, clotting factors, and immunoglobulins, and less‐predictable allergic reactions, perturbations of haemodynamic stability, and complications of vascular access. Complications of TPE in children occur in 28% to 82% of patients or 14% to 55% of exchange procedures, occurring more commonly than in adults because of numerous factors predominantly related to reduced reporting of early symptoms, smaller size, and smaller circulating volume . In the present study the most common complication was hypocalcaemia, occurring in 19% of courses.…”

Section: Discussionmentioning

confidence: 46%

“…However, these and similar guidelines issued by the American Academy of Neurology do not distinguish between adults and children in their recommendations. Children are at increased risk of haemodynamic instability and other complications of TPE because of differences in weight, vascular access, management of anticoagulation, and other factors, as recently reviewed . Additionally, there is a lack of quality data regarding the efficacy of TPE for many disorders in children …”

mentioning

confidence: 99%

See 1 more Smart Citation

Utility and safety of plasma exchange in paediatric neuroimmune disorders

Eyre

Hacohen

Lamb

et al. 2019

Develop Med Child Neuro

Self Cite

View full text Add to dashboard Cite

Aim Our aim was to ascertain the indications, side effects, and outcomes in children receiving therapeutic plasma exchange (TPE) for neurological disorders. Method Medical records were retrospectively reviewed for 58 consecutive children (age ≤16y) undergoing 67 courses of TPE across four tertiary centres. Patient characteristics, treatment schedules, complications, and outcomes were analysed. Results Median age at initiation of TPE was 9 years (range 1–15y). Indications included peripheral nervous system (PNS; n=18) and central nervous system (CNS; n=40) disorders. Courses comprised a median six exchanges (range 2–179) over 8 days (range 3–466). Forty‐two out of 58 (73%) children were severely disabled (bedridden) at initiation and 24 out of 58 (41%) were admitted to intensive care units. Treating clinicians’ impression of response was positive in 16 out of 18 of those with PNS disorders versus 22 out of 40 with CNS disorders (p=0.016). Improvements in disability (modified Rankin Scale) occurred in 13 out of 58 (22%) children by completion of TPE (p=0.003). Complications occurred in 40 out of 67 (60%) courses, of which 16 out of 67 (24%) were line related. Potentially life‐threatening complications occurred in 2 out of 67 (3%) courses. Interpretation This cohort study provides safety and efficacy information for clinicians and families and a basis for future prospective studies. What this paper adds Disability scores for severe neuroimmune disorders remained stable or improved during therapeutic plasma exchange treatment. Complications occurred frequently but were typically mild and correctable.

show abstract

Section: Discussionmentioning

confidence: 46%

mentioning

confidence: 99%

Utility and safety of plasma exchange in paediatric neuroimmune disorders

Eyre

Hacohen

Lamb

et al. 2019

Develop Med Child Neuro

Self Cite

View full text Add to dashboard Cite

show abstract

“…The use of plasma exchange in this condition is supported by a strong rationale, and anti‐NMDAR encephalitis was included in the latest guidelines on the use of therapeutic apheresis in clinical practice by the American Society for Apheresis . However, the literature on the efficacy of plasma exchange compared to other treatments in anti‐NMDAR encephalitis is scarce and mainly uncontrolled, and the use of plasma exchange in children may be limited by the low body weight and the potential side effects, and is influenced by the expertise of the treating centres . Rituximab has been shown to be useful and relatively safe in paediatric neurology, although severe adverse reactions including infections are possible; its use has been increasing, as shown by our cohort, and is supported by the demonstration of CD19(+) B‐cell expansion in anti‐NMDAR encephalitis .…”

Section: Discussionmentioning

confidence: 99%

Relapse risk factors in anti‐N‐methyl‐D‐aspartate receptor encephalitis

Nosadini

Granata²,

Matricardi³

et al. 2019

Develop Med Child Neuro

View full text Add to dashboard Cite

Aim To identify factors that may predict and affect the risk of relapse in anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis. Method This was a retrospective study of an Italian cohort of patients with paediatric (≤18y) onset anti‐NMDAR encephalitis. Results Of the 62 children included (39 females; median age at onset 9y 10mo, range 1y 2mo–18y; onset between 2005 and 2018), 21 per cent relapsed (median two total events per relapsing patient, range 2–4). Time to first relapse was median 31.5 months (range 7–89mo). Severity at first relapse was lower than onset (median modified Rankin Scale [mRS] 3, range 2–4, vs median mRS 5, range 3–5; admission to intensive care unit: 0/10 vs 3/10). At the survival analysis, the risk of relapsing was significantly lower in patients who received three or more different immune therapies at first disease event (hazard ratio 0.208, 95% confidence interval 0.046–0.941; p=0.042). Neurological outcome at follow‐up did not differ significantly between patients with relapsing and monophasic disease (mRS 0–1 in 39/49 vs 12/13; p=0.431), although follow‐up duration was significantly longer in relapsing (median 84mo, range 14–137mo) than in monophasic patients (median 32mo, range 4–108mo; p=0.002). Interpretation Relapses may occur in about one‐fifth of children with anti‐NMDAR encephalitis, are generally milder than at onset, and may span over a long period, although they do not seem to be associated with severity in the acute phase or with outcome at follow‐up. Aggressive immune therapy at onset may reduce risk of relapse. What this paper adds Relapses of anti‐N‐methyl‐D‐aspartate receptor encephalitis may span over a long period. Relapses were not associated with severity in the acute phase or outcome at follow‐up. Aggressive immune therapy at onset appears to decrease risk of relapse.

show abstract

“…Eyre et al . have helped close this gap in the literature with original data on a large neuroimmunology cohort of 58 children undergoing TPE in four UK centres, which follows‐up an extremely useful critical literature review on TPE in paediatric neurology …”

mentioning

confidence: 99%

“…cohort, 66% of clinicians reported an immediate benefit with TPE, more manifest in peripheral nervous system (PNS) rather than central nervous system (CNS) disorders, despite similar modified Rankin Scale (mRS) change at TPE completion. Indeed, the blood–brain barrier and the possibility of intrathecal antibody production may account for slower TPE effects in CNS compared to PNS disorders, where serum disease mediators have direct access to their targets …”

mentioning

confidence: 99%