Value of plasmapheresis in hepatic encephalopathy.
Plasmapheresis is used for treating the complications of liver failure. We performed plasmapheresis on 6 children with hepatic encephalopathy resulting from acute hepatic failure and prospectively assessed its effects on neurologic and electrophysiologic (electroencephalography and evoked potentials) function. Clinical improvement was observed in 3 of 6 patients; changes in the serum ammonia value or the results of initial electrophysiologic tests did not predict the patient response. Two patients underwent transplantation after neurologic improvement was produced by plasmapheresis; however, despite plasmapheresis, 4 patients progressed to brain death. Our data demonstrate that plasmapheresis may transiently improve the encephalopathy of acute hepatic failure but is not curative alone. Therefore, plasmapheresis may be a useful adjunct in the treatment of liver failure, potentially improving the pretransplantation status of the patient.
Riviello
J J
JJ
Section of Child Neurology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Halligan
G E
GE
Dunn
S P
SP
Widzer
S J
SJ
Foley
C M
CM
Breningstall
G N
GN
Grover
W D
WD
D001933:Brain Stem / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D009460:Neurologic Examination; D010956:Plasmapheresis