Related Experiment Video
Updated: Apr 21, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Plasma Exchange as a Bridge to Recovery in Severe Pediatric Neurological Diseases in Pediatric Intensive Care
Güntülü Şık1, Gamze Başak1, Tuğba Kanar1
1Department of Pediatric Intensive Care, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye.
Insights
Therapeutic plasma exchange (TPE) shows promise for pediatric neurocritical care, with 83% of patients improving. Early TPE initiation (within 7 days) correlated with better outcomes, and the procedure was found to be safe in children.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Immunology
Background:
- Therapeutic plasma exchange (TPE) is established in adult neurology but lacks extensive evidence in pediatric neurocritical care.
- Limited data exists on the safety and efficacy of TPE for immune-mediated neurological disorders in children.
Purpose of the Study:
- To assess the indications, clinical effectiveness, and safety of TPE in pediatric patients with acute or subacute immune-mediated neurological conditions.
- To evaluate TPE's role in the pediatric intensive care unit (PICU) setting.
Main Methods:
- Retrospective cohort study of 24 pediatric patients (1-18 years) treated with TPE.
- Analysis of diagnoses including multiple sclerosis, Guillain-Barré syndrome, ADEM, transverse myelitis, autoimmune encephalitis, optic neuritis, and myasthenia gravis.
- Clinical response assessed using modified Rankin Scale (mRS) and GBS disability scores pre- and post-TPE.
Main Results:
- 83% of patients (20/24) showed clinical improvement, with 33% experiencing moderate improvement.
- Median mRS/GBS scores significantly decreased from 4.0 to 3.0 (p=0.001).
- Early TPE initiation (≤7 days from onset) was linked to improved neurological outcomes; no life-threatening complications were observed.
Conclusions:
- TPE is a safe and potentially effective treatment for severe pediatric neuroimmunological disorders.
- Earlier TPE initiation may lead to better neurological outcomes, supporting its integration into PICU management.
- Further research with larger sample sizes is warranted to confirm these findings in diverse pediatric neuroimmunology cases.
Background:
Therapeutic plasma exchange (TPE) removes circulating pathogenic antibodies, immune complexes, cytokines, and complement components. While established in adult neurology, evidence on its safety and efficacy in pediatric neurocritical care remains limited.
Objective:
To evaluate the indications, clinical efficacy, and safety of TPE in children with acute or subacute immune-mediated neurological disorders admitted to the pediatric intensive care unit (PICU).
Methods:
A retrospective cohort of 24 pediatric patients (aged 1-18 years) treated with TPE between February 2023 and October 2025 was analyzed. Diagnoses included multiple sclerosis (n = 8), Guillain-Barré syndrome (n = 5), acute disseminated encephalomyelitis (n = 3), transverse myelitis (n = 3), autoimmune encephalitis (n = 3), optic neuritis (n = 1), and myasthenia gravis (n = 1). Patients received 3-7 TPE sessions. Clinical response was measured using the modified Rankin Scale (mRS) and GBS disability scores before and after treatment.
Results:
A total of 130 sessions were performed. Clinical improvement occurred in 20 of 24 patients (83%)-moderate in 8 (33%) and mild in 12 (50%). Median mRS/GBS scores decreased from 4.0 to 3.0 (p = 0.001). Early initiation of TPE (≤ 7 days from symptom onset) was associated with a higher likelihood of neurological improvement in multivariable analysis. No life-threatening complications were observed. Transient, reversible events included hypocalcemia (2.3%), hypotension (1.5%), and urticaria (1.6%).
Conclusion:
TPE appears to be a safe and potentially beneficial intervention for severe or refractory pediatric neuroimmunological disorders. Earlier initiation of TPE was associated with improved neurological outcomes; however, these findings should be interpreted cautiously given the small sample size and heterogeneous disease groups. These findings support integrating TPE into multidisciplinary PICU management and add to the growing evidence supporting its use in pediatric neuroimmunology.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Continuous Renal Replacement Therapy
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration