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Abstract Details

Feasibility & Safety of Plasma Exchange in Pediatric Neuro-immunology: A Single Center Experience
Autoimmune Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
15-006
Among neurological conditions, currently TPE is standard of care in acute inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, and myasthenia crisis. At present, for the treatment of autoimmune encephalitis, first-line immunosuppressive therapies include corticosteroids, intravenous immunoglobulin (IVIG) therapy, and/or TPE; however the order of these treatments, and various combinations are not well defined.
There is limited data available on the safety of therapeutic plasma exchange (TPE) for pediatric neuro-immunological disorders (PNID). In this study, we report our data on safety and feasibility of TPE for these disorders in a single tertiary care center. 
Retrospective chart review was performed to include all patient who received TPE for four major PNID conditions: autoimmune encephalitis (AIE), acute disseminated encephalomyelitis (ADEM), Neuromyelitis optic spectrum disorder (NMOSD) and transverse myelitis (TM). We recorded minor and major adverse effects (AEs) associated with each TPE procedure. Secondary analysis also looked at the efficacy data of TPE on these patients.
Thirty-two patients with PNID received a total of 186 TPE cycles. Out of these, only 1 cycle (0.89%) in AIE subgroup, 1(4.3%) in NMOSD and 1 (4.5%) in TM had adverse effects. No patients had major side effects. Twenty-one kids (65.6%) had significant improvement in symptoms after 5-7 day course of TPE. Three (9.3%) had moderate improvement from baseline. Eight (25%) showed no or minimal improvement. 

TPE by centrifugation technique is a useful and readily available treatment option. In this study, we have shown that with a skilled and experienced team, TPE is an effective life-saving therapeutic intervention with minimal AEs in various PNID even when used early. In centers with experience in performing TPE, it should be considered earlier in the course of the disease, and possibly before IVIG use.

Authors/Disclosures
Padmavati Rajdatta Eksambe, MD
PRESENTER
Dr. Eksambe has nothing to disclose.
Yash Shah, MD, MBBS, MPH (OLOL) Dr. Shah has nothing to disclose.
Katayoun Fomani No disclosure on file
James Louie No disclosure on file
Shefali Karkare, MD (Cohen Childrens Medical Center) Dr. Karkare has nothing to disclose.
Sanjeev V. Kothare, MD, FAAN (Cohen Children's Hospital, Northwell Health) Dr. Kothare has nothing to disclose.