Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating DiseaseKoziolek M.a · Mühlhausen J.a · Friede T.b · Ellenberger D.b · Sigler M.c · Huppke B.d · Gärtner J.d · Müller G.-A.a · Huppke P.d
Departments of aNephrology and Rheumatology, bMedical Statistics, cPediatric Cardiology and Pediatric Intensive Care Medicine and dPediatrics and Pediatric Neurology, University Medical Center, Georg August University Göttingen, Göttingen, Germany
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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.
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