title: Therapeutic plasma exchange in children with acute autoimmune central nervous system disorders.
abstract: BACKGROUND
  There is a growing evidence for autoimmunity in acute central nervous system (CNS) disorders and treatment with therapeutic plasma exchange (TPE) may be considered. The aim was to share our experience on the clinical application of TPE in these disorders and to present a reproducible protocol which can be used even in small children.
  
  
  METHODS
  We present a series of 8 children aged 2-12 years with transverse myelitis, Bickerstaff's brainstem encephalitis, neuromyelitis optica, and acute paraneoplastic or unspecified encephalitis in whom TPE was used as a second-line or rescue treatment.
  
  
  RESULTS
  A total of 104 TPE sessions were performed where 80-110 ml/kg of plasma was exchanged using 4% albumin solution and fresh frozen plasma. Six episodes of TPE-related adverse events were documented. Fibrinogen concentrations decreased after the first TPE, whereas platelets decreased gradually. One patient died in the course of the acute illness. Three children achieved a complete resolution of symptoms, 2 children have mild sequelae; whereas 2 children remain paraplegic after a follow-up of 3 to 17 months.
  
  
  CONCLUSIONS
  We report 8 children with presumably autoimmune-mediated, acute CNS disorders treated with TPE as a rescue therapy. Although the effect of TPE can only be inferred, 5 children had a good clinical outcome. TPE is feasible even in small children with acute autoimmune CNS disorders.
authors.affiliation: Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent - Belgium.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Prytuła
authors.affiliation: Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent - Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
authors.affiliation: Pediatric Neurology and Metabolic Disease Department, Ghent University Hospital, Ghent - Belgium.
authors.forename: Helene
authors.initials: H
authors.lastname: Verhelst
authors.affiliation: Hemodialysis Unit, Ghent University Hospital, Ghent - Belgium.
authors.forename: Sunny
authors.initials: S
authors.lastname: Eloot
authors.affiliation: Hemodialysis Unit, Ghent University Hospital, Ghent - Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Claus
authors.affiliation: Pediatric Intensive Care Unit, Ghent University Hospital, Ghent - Belgium.
authors.forename: Annick
authors.initials: A
authors.lastname: De Jaeger
authors.affiliation: Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent - Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Dehoorne
authors.affiliation: Pediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent - Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Raes
mesh_terms: D000208:Acute Disease; D020274:Autoimmune Diseases of the Nervous System / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D010951:Plasma Exchange; D010956:Plasmapheresis; D010976:Platelet Count; D012189:Retrospective Studies
chemical_list: D005340:Fibrinogen