Clinical response to therapeutic plasma exchange in patients with immune-mediated inflammatory diseases of the central nervous system.

INTRODUCTION

Inflammatory immune-mediated diseases of the central nervous system, such as autoimmune encephalitis, acute disseminated encephalomyelitis or Guillain-Barré syndrome, pose diagnostic and therapeutic challenges in the pediatric population. Therapeutic plasma exchange has emerged as a useful option in these cases. This study evaluated the clinical response to therapeutic plasma exchange in children with these conditions.

METHODS

We conducted a retrospective cohort study at Fundación Hospital Pediátrico La Misericordia in Bogotá (2018-2022), including 50 patients with a confirmed diagnosis of antibody-mediated inflammatory disease of the central nervous system who were managed with therapeutic plasma exchange. We collected data on clinical, therapeutic and outcome variables and performed descriptive, survival, and Cox regression analyses.

RESULTS

The mean age was 10 years, with a uniform sex distribution. The most frequent conditions were autoimmune encephalitis (36%) and acute disseminated encephalomyelitis (14%). At discharge, 56% of patients had persistent neurologic symptoms and 46% had recovered their prior functional status. The mortality was 6%. The use of antiepileptic drugs was significantly associated with a lower risk of relapse (hazard ratio, 0.081; P = .024) and steroid use with increased survival, particularly in patients with autoimmune encephalitis, acute disseminated encephalomyelitis and myasthenia gravis (P < .05).

CONCLUSION

Therapeutic plasma exchange is a viable and safe treatment strategy for children with immune-mediated inflammatory diseases of the central nervous system. The concomitant use of antiepileptic drugs and steroids showed benefits in reducing relapse and mortality.