title: Outcomes after early administration of plasma exchange in pediatric central nervous system inflammatory demyelination.
abstract: The use of plasma exchange has been described in steroid-refractory central nervous system inflammatory demyelination in adults, but less has been published regarding its use in children and adolescents. We describe 12 children treated with plasma exchange for acute severe central nervous system inflammatory demyelination. The clinical attack leading to plasma exchange included symptomatic spinal cord lesions in 10 and symptomatic brainstem lesions in 2 children. Diagnosis was acute transverse myelitis in 6, relapsing-remitting multiple sclerosis in 5, and acute disseminated encephalomyelitis in 1 child. Adverse events related to plasma exchange necessitating intervention were observed in 3 children. Median Expanded Disability Status Scale score at plasma exchange start was 7.5 (range 4-9.5). At 3 months, 7 children were ambulatory without aid (Expanded Disability Status Scale score of ≤4). This retrospective study suggests that plasma exchange can be effective in ameliorating symptoms in severe pediatric central nervous system inflammatory demyelination, although lack of randomization or control group limits the ability to attribute this outcome entirely to plasma exchange.
authors.affiliation: The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada Sandra.Bigi@insel.ch sandra.bigi@gmx.ch.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bigi
authors.affiliation: The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada The Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, PA, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
authors.affiliation: The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D004673:Encephalomyelitis, Acute Disseminated / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000628:therapy*; D009188:Myelitis, Transverse / Q000628:therapy*; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: central nervous system inflammatory demyelination; pediatric; plasma exchange