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Therapeutic apheresis in pediatric patients with acute CNS inflammatory demyelinating disease
Michael Koziolek1, Johannes Mühlhausen, Tim Friede
1Department of Nephrology and Rheumatology, Georg August University Göttingen, Göttingen, Germany.
Insights
Plasma exchange (PE) and immunoadsorption are safe and effective treatments for pediatric patients experiencing severe relapses of central nervous system (CNS) demyelinating diseases, showing significant recovery.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Therapeutic Apheresis
Background:
- Plasma exchange (PE) is an established treatment for severe acute inflammatory central nervous system (CNS) demyelinating diseases in adults.
- Limited data exists on the efficacy and safety of apheresis in pediatric populations with these conditions.
Purpose of the Study:
- To evaluate the safety and efficacy of apheresis, specifically plasma exchange (PE) and immunoadsorption, in pediatric patients with inflammatory CNS demyelinating disorders.
Main Methods:
- Retrospective analysis of a single-center cohort of pediatric patients undergoing apheresis between 2007 and 2011.
- Patients diagnosed with acute relapse of multiple sclerosis, neuromyelitis optica, or acute disseminated encephalomyelitis were included.
- Treatment involved methylprednisolone followed by PE or immunoadsorption.
Main Results:
- Ten pediatric patients (mean age 11.6 years) were treated.
- Apheresis-related side effects were minimal and manageable.
- Significant improvement in Expanded Disability Status Scale (EDSS) scores was observed (median 7.5 to 1, p < 0.01).
- Initial transient worsening of visual acuity was followed by complete recovery.
Conclusions:
- Apheresis, including PE and immunoadsorption, is well-tolerated in pediatric patients with inflammatory CNS demyelinating diseases.
- The treatment is associated with favorable clinical outcomes, mirroring findings in adult populations.
Background/Aims:
In adults, plasma exchange (PE) has been shown to be an efficient treatment for severe relapses of acute inflammatory CNS demyelinating diseases. The aim of this study was to evaluate the safety and efficacy of this treatment in pediatric patients.
Methods:
We retrospectively analyzed a single-center cohort of pediatric patients with inflammatory CNS demyelinating disorders who underwent apheresis between 2007 and 2011.
Results:
Ten patients (mean age: 11.6 ± 3.4 years) with an acute relapse of multiple sclerosis (n = 5), neuromyelitis optica (n = 2) or acute disseminated encephalomyelitis were included. All received methylprednisolone prior to treatment with either PE (n = 5) or immunoadsorption (n = 5). Apheresis-related side effects were either self-limiting or easily managed. EDSS (Expanded Disability Status Scale) improved in 7 of 8 patients during apheresis and in all patients within 30 days from a median of 7.5 to 1 (p < 0.01). The visual acuity initially worsened during the procedure in 3 of 7 affected eyes (mean 0.09), but improved in all at follow-up (mean: 0.5; p = 0.008).
Conclusions:
Apheresis was well tolerated and associated with a favorable outcome in all pediatric patients similar to reports in adults.
