Therapeutic Plasma exchange as An Emerging Treatment Modality in Neurologic Disorders – An Experience in Pediatric Population.

Abstract

Objective: Therapeutic plasma exchange (TPE) is a modality to treat neurologic diseases like Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), inflammatory demyelinating disorders of CNS, autoimmune encephalitis and many others. This study is designed for evaluation of efficacy and safety of TPE either a first line therapy or as an adjunct to other initial treatments in patients with neurologic diseases.

Study Design: It is an observational study of descriptive type.

Study duration and place: This study is the joint venture of Department of Paediatric Neurology, Pediatric intensive care unit and Hematology at The Children’s hospital Lahore from October 2021 till December 2023.

Methods: TPE was performed on every alternate day, with total of 3-5 sessions. Vascular access was gained by femoral or jugular double lumen catheter and we used apheresis machine FRESENIUS KABI. FFPs was used as replacement fluid. Patients were assessed before and after TPE procedures for clinical and functional status using GMFCS and MRCS scores and paired t- test was applied to measure it statistically.

Results: 134 procedures were done on 30 patients. The study population has mean age of 7.84 ±3.6years (range is 2-14 years), the males were 56.6% while females were 43.3%. Most common disease was GBS (60%), predominantly axonal variant (60%) followed by NMOSD (16.6%), NMDAR encephalitis (10%) and 6.6% each of MOGAD and CIDP. Mechanical ventilation was required in 56.7 % (n=17) and all these patients developed autonomic dysfunction. Improvement in terms of function and motor power was measured both before and after plasmapheresis using GMFCS and MRCS score and found a very low p-value of 0.000 in both pairs, which is significant statistically.

Conclusion: TPE is an effective and safe therapeutic modality in pediatric population with neurologic disorders especially in resource constraint settings. 

Key words: Therapeutic plasma exchange (TPE), Guillain-Barre syndrome (GBS), Neurologic diseases.