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Plasmapheresis for refractory status epilepticus Part II: A scoping systematic review of the pediatric literature
F A Zeiler1, M Matuszczak2, J Teitelbaum3
1Clinician Investigator Program, University of Manitoba, Winnipeg, Canada.
Insights
Plasma exchange (PE) shows limited benefit for pediatric refractory status epilepticus (RSE). This review found a low response rate, suggesting PE is not routinely recommended for RSE in children.
Area of Science:
- Neurology
- Pediatrics
- Critical Care Medicine
Background:
- Refractory status epilepticus (RSE) in children presents a significant clinical challenge.
- Plasmapheresis or plasma exchange (PE) is a potential treatment modality for RSE.
- Evidence for PE efficacy in pediatric RSE requires systematic evaluation.
Purpose of the Study:
- To conduct a scoping systematic review of literature on PE for pediatric RSE.
- To assess the effectiveness and safety of PE in this patient population.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, Scopus, etc.) and gray literature.
- Inclusion of original articles reporting on pediatric patients treated with PE for RSE.
- Adjudication of evidence strength using Oxford and GRADE methodologies by two independent reviewers.
Main Results:
- Twenty-two articles involving 37 pediatric patients were reviewed.
- Only 9 of 37 patients (24.3%) showed any seizure response to PE (7 with resolution, 2 with partial reduction).
- A significant majority (75.7%) experienced no response, with no adverse events reported.
Conclusions:
- The current evidence (Oxford level 4, GRADE D) suggests minimal to no benefit of PE for pediatric RSE.
- Routine use of PE for pediatric RSE is not recommended based on available data.
Background:
Our goal was to perform a scoping systematic review of the literature on the use of plasmapheresis or plasma exchange (PE) for refractory status epilepticus (RSE) in children.
Methods:
Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to May 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers.
Results:
Twenty-two original articles were identified, with 37 pediatric patients. The mean age of the patients was 8.3 years (age median: 8.5, range: 0.6 years-17 years). Seizure response to PE therapy occurred in 9 of the 37 patients (24.3%) included in the review, with 7 patients (18.9%) displaying resolution of seizures and 2 patients (5.4%) displaying a partial reduction in seizure volume. Twenty-eight of the 37 patients (75.7%) had no response to PE therapy. No adverse events were recorded.
Conclusions:
Oxford level 4, GRADE D evidence exists to suggest little to no benefit of PE in pediatric RSE. Routine application of PE for pediatric RSE cannot be recommended at this time.
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