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Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm

Michael Eyre1,2, Yael Hacohen1,3, Carmen Barton4

  • 1Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.

Developmental Medicine and Child Neurology
|June 2, 2018
PubMed

Insights

Therapeutic plasma exchange (TPE) is an important immunotherapy for pediatric neurological conditions, but more research is needed to optimize its use and understand its benefits. Current evidence suggests TPE is effective but requires careful management of side effects.

Area of Science:

  • Pediatric Neurology
  • Immunotherapy
  • Neuroinflammation

Background:

  • Therapeutic plasma exchange (TPE) is a recognized immunotherapeutic strategy for acute neurological syndromes.
  • Its application in pediatric neurological conditions is reviewed, highlighting challenges due to rarity and incomplete pathobiology understanding.
  • Limited large-scale controlled trials exist for TPE in children.

Purpose of the Study:

  • To review the indications, evidence strength, and safety of TPE in pediatric neurological conditions.
  • To identify areas requiring further research for optimizing TPE therapy in children.
  • To discuss evolving technologies like immunoadsorption in the context of TPE.

Main Methods:

  • Review of existing literature on TPE in pediatric neurological disorders.
  • Analysis of current evidence regarding efficacy, safety, and dosing.
  • Discussion of comparative TPE methods and integration with other immunotherapies.

Main Results:

  • TPE shows evidence of efficacy in childhood neuro-inflammatory conditions, though studies are often small and uncontrolled.
  • TPE is generally well-tolerated when adverse effects are anticipated and managed.
  • Uncertainty persists regarding optimal TPE dosing, monitoring, and comparison of different methods.

Conclusions:

  • Further research is crucial to define TPE indications and benefits in pediatric neurology.
  • Systematic dosing and objective assessment of treatment effects are priorities for future studies.
  • Evolving technologies like immunoadsorption warrant further investigation for TPE applications.

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