Therapeutic plasma exchange in multifocal motor neuropathy

Background: Therapeutic plasma exchange (TPE) is a procedure used in neurological disorders where autoimmunity plays a major role. Though it is a relatively safe procedure, severe complications may occur.Objective: The aim of the present study was to analyze the incidence of TPE related complications in patients with different neurological disorders.Methodology: This prospective study was conducted in 91 patients, in department of Transfusion Medicine at National Institute of Neurosciences and Hospital (NINS) from February 2014 to January 2017 for a period of three (03) years. All admitted patients with neurological disorders advised for TPE were included in this study.Results: Age range was from 13 to 70 years with a mean age of 37.14±13.79 years. 67(74%) were men and 24(26.0%) were women. The most common diagnosis was Guillain-Barré Syndrome (GBS) in 79.1 % (n=72) cases followed by myasthenia gravis (MG) in 13.2% (n=12), chronic inflammatory demyelinating polyneuropathy (CIDP) in 6.6 % (n= 6), multifocal motor neuropathy (MMN) in 1.1% (n=1) cases. Total number of 332 TPE sessions was performed with the median of 4 sessions per patient (range 1 to 9). Total 99 (29.8%) adverse reactions occurred in 332 TPE sessions. The most common adverse effect was hypotension (n=35, 10.54 %) followed by allergic reactions (n=29, 8.73 %), access problem (n= 12, 3.61 %) and vomiting (n=8, 2.41 %). Most of the adverse reactions were mild and improved spontaneously or by using simple medications. Out of 332 TPE sessions, 330(99.4%) procedures were completed successfully after managing the adverse reactions. TPE were discontinued in 2 occasions (0.6% of procedures) due to inadequate venous access. There was no mortality related to TPE procedure.Conclusion: In spite of few complications, TPE can be considered as a safe method of treatment in neurologic disorders when carried out with all necessary precautions.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 69-74

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The clinical value of therapeutic plasma exchange in multifocal motor neuropathy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2008.02.022 ◽

2008 ◽

Vol 271 (1-2) ◽

pp. 34-39 ◽

Cited By ~ 26

Author(s):

Helmar C. Lehmann ◽

Felix R. Hoffmann ◽

Andreas Fusshoeller ◽

Gerd Meyer zu Hörste ◽

Rüdiger Hetzel ◽

...

Keyword(s):

Plasma Exchange ◽

Multifocal Motor Neuropathy ◽

Therapeutic Plasma Exchange ◽

Motor Neuropathy ◽

Clinical Value

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Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

F1000Research ◽

10.12688/f1000research.11841.1 ◽

2017 ◽

Vol 6 ◽

pp. 1234 ◽

Cited By ~ 3

Author(s):

Osman Sinanović ◽

Sanela Zukić ◽

Adnan Burina ◽

Nermina Pirić ◽

Renata Hodžić ◽

...

Keyword(s):

Myasthenia Gravis ◽

Clinical Response ◽

Plasma Exchange ◽

Neurological Diseases ◽

Therapeutic Plasma Exchange ◽

Motor Neuropathy ◽

Extracorporeal Blood Purification ◽

Clinical Center ◽

Plasma Factor ◽

Neurological Patients

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016. Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

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Childhood-Onset Multifocal Motor Neuropathy with IgM Antibodies to Gangliosides GM1: A Case Report with Poor Outcome

Neuropediatrics ◽

10.1055/s-0040-1722677 ◽

2021 ◽

Author(s):

Stefano Pro ◽

Fabiana Ursitti ◽

Gian Luca Pruneddu ◽

Matteo Di Capua ◽

Massimiliano Valeriani

Keyword(s):

Case Report ◽

Plasma Exchange ◽

Intravenous Immunoglobulin ◽

Oral Prednisone ◽

Multifocal Motor Neuropathy ◽

Ivig Treatment ◽

Motor Neuropathy ◽

Childhood Onset ◽

Igm Antibodies ◽

Facial Diplegia

Abstract Background Multifocal motor neuropathy (MMN) is a slowly progressive motor neuropathy characterized by asymmetric muscle weakness without sensory involvement. Typically, MMN respond completely to treatment with intravenous immunoglobulin (IVIg). MMN is even rarer in the pediatric population, where only five patients have been reported up to now. Case Report We discuss the 3-year follow-up of a 13-year-old girl with MMN who was positive for IgM antibodies to gangliosides GM1. She was diagnosed with MMN in accordance with the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria. Serological studies revealed that she tested positive for IgM antibodies to GM1. She underwent intravenous methylprednisolone followed by an oral prednisone taper, intravenous immunoglobulin (IVIg), plasma exchange followed by IVIG and prednisone and Rituximab. No improvement was referred. At the present, she shows flaccid tetraplegia, facial diplegia, and bulbar cranial nerve palsy. Conclusion Although childhood onset MMN is rare, most patients reported in literature respond to IVIg treatment. In a few cases, however, IVIg can be ineffective. In our patient, IVIg as well as treatment with prednisolone, plasma exchange and rituximab have failed.

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Deterioration of multifocal motor neuropathy after plasma exchange

Neurology ◽

10.1212/wnl.50.5.1480 ◽

1998 ◽

Vol 50 (5) ◽

pp. 1480-1482 ◽

Cited By ~ 80

Author(s):

M. Carpo ◽

A. Cappellari ◽

G. Mora ◽

R. Pedotti ◽

S. Barbieri ◽

...

Keyword(s):

Plasma Exchange ◽

Multifocal Motor Neuropathy ◽

Motor Neuropathy

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Intravenous immunoglobulin treatment in multifocal motor neuropathy and other chronic immune-mediated neuropathies

Multiple Sclerosis Journal ◽

10.1177/135245859700300207 ◽

1997 ◽

Vol 3 (2) ◽

pp. 93-97 ◽

Cited By ~ 6

Author(s):

G. Comi ◽

R. Nemni ◽

S. Amadio ◽

G. Galardi ◽

L. Leocani

Keyword(s):

Plasma Exchange ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Case Series ◽

Multifocal Motor Neuropathy ◽

Initial Therapy ◽

Motor Neuropathy ◽

Short Term ◽

Term Efficacy ◽

Immune Mediated

This review deals with the use of intravenous IVIg immunoglobulines in the treatment of chronic immune-mediated neuropathies: multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, neuropathies associated with monoclonal gammopathies. A particular attention is given to case series and trials which compare IVIg to other therapies, such as steroid treatment, immunosuppressors and plasma exchange. At present, clinical and instrumental data seem to indicate the short term efficacy of IVIg in multifocal motor neuropathies, especially as early treatment; further studies are need in order to prove its long term efficacy in this disease. Concerning chronic inflammatory demyelinating polyneuropathies, short term IVIg efficacy is comparable to that of plasma exchange and in the long term most patients need repeated treatments. Most patients respond to the initial therapy and the initial nonresponders usually improve with a second treatment modality.

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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