Variable response to therapeutic plasma exchange in pediatric anti-NMDA receptor encephalitis
Archana Naik1, Satya Prakash1, Gopal Krushna Ray1
1Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Insights
Therapeutic plasma exchange is a crucial treatment for anti-NMDA receptor encephalitis in children. Timely initiation of this therapy, alongside immunosuppressants, improves patient outcomes and reduces hospitalization.
Area of Science:
- Neurology
- Immunology
Background:
- Anti-NMDA receptor encephalitis presents acutely with movement and psychiatric disturbances.
- Therapeutic plasma exchange is a primary treatment consideration for this condition.
- This study focuses on pediatric patients with severe anti-NMDA receptor encephalitis.
Purpose of the Study:
- To evaluate the role and effectiveness of therapeutic plasma exchange in pediatric patients with severe anti-NMDA receptor encephalitis.
- To analyze the outcomes of plasma exchange in this specific patient group.
Main Methods:
- Retrospective analysis of four pediatric cases with severe anti-NMDA receptor encephalitis.
- Evaluation of clinical and laboratory profiles prior to plasma exchange.
- Plasma exchange performed using Cobe Spectra with albumin and fresh frozen plasma as replacement fluid.
Main Results:
- A total of 20 procedures were performed across four patients (2-8 per patient).
- Patients experienced slow recovery and prolonged hospitalization (25-70 days), potentially due to delayed plasma exchange initiation.
- One patient was lost to follow-up, and another experienced a fatal outcome post-discharge.
Conclusions:
- Early diagnosis and prompt initiation of therapeutic plasma exchange are vital for anti-NMDA receptor encephalitis.
- Timely plasma exchange, combined with immunosuppressive therapy, accelerates recovery and reduces hospital stay.
- This approach leads to significantly better patient outcomes.
Introduction:
Anti-NMDA receptor encephalitis in an acute form generally presents with abnormal movements and psychiatric symptoms. Therapeutic plasma exchange has been considered to be one of the first line treatment options. This report highlights the role of plasma exchange in anti-NMDA receptor encephalitis in pediatric patients.
Methods:
This is a retrospective analysis of four cases of a severe form of encephalitis due to anti-NMDA receptor antibody. All these four patients were evaluated for clinical and laboratory profile before plasma exchange. Plasma exchange was performed with Cobe Spectra Version 7.0(Terumo BCT, USA), and 5% albumin and fresh frozen plasma were used as replacement fluid.
Results:
A total of 20 procedures (range: 2-8/patient) were performed on four patients on an alternate day basis. Slow recovery and long-term hospitalization (range: 25-70 days) was observed in all these patients and may be due to delayed initiation of plasma exchange. One patient was lost in follow up while another one had fatal consequences after one month of discharge from the hospital.
Conclusion:
Early diagnosis and timely initiation of therapeutic plasma exchange along with immunosuppressive therapy hasten the recovery, duration of hospitalization and yield a better outcome.
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