Abstract Details

Title Plasma Exchange in Pediatric CNS Inflammatory Demyelination

Topic MS and Related Diseases

Presentation(s) P02 - (-)

Poster/Presentation
Number 119

Objective

Background BACKGROUND: PLEX has been described in steroid refractory CNS inflammatory demyelination in adults, but few is known for children with severe CNS inflammatory demyelination.

Design/Methods DESIGN/METHODS: Retrospective review of prospectively collected data from 297 consecutive children presenting at a tertiary pediatric MS center between 1999-2012. Written informed consent was obtained. Case report forms, charts and MRI scans were reviewed for all children who received PLEX. Level of disability was scored using the expanded disability status scale (EDSS) and evaluated at PLEX start, at discharge and at 3 months after PLEX.

Results RESULTS: 12 patients (9 female) were identified (average age 12y, range 7-18y). Diagnosis was relapsing-remitting MS in 5/12, acute transverse myelitis in 6/12, and ADEM in 1/12. Index attack leading to PLEX was a symptomatic cord lesion in 10/12 and a symptomatic brainstem lesion in 2/12. Therapy preceding PLEX included methylprednisolone in 7/12, IVIG in 1/12, methylprednisolone and IVIG in 2/12. 2/12 received PLEX as initial therapy. Median time from symptom onset to PLEX was 6 days (range 1-24). Median EDSS at PLEX start was 7.25 (range 4-9.5). Three children experienced: hypersensitivity reaction (1), anemia necessitating transfusion (1), thrombosis (1), hypotension necessitating intravenous fluids (2). Median EDSS at discharge was 5.75 (range 2-9.5) and at 3 months 4 (range 0-8.5). At 3 months, 7/12 had an EDSS of ? 4.

Conclusions CONCLUSIONS: We describe our experience with PLEX in children with severe CNS inflammatory demyelination. Side effects necessitating intervention were observed in 25%. Over half of the children in this series regained independent ambulation 3 months after PLEX. Given the retrospective nature and small cohort, prospective studies in larger pediatric cohorts are warranted.

Authors/Disclosures
Sandra Bigi PRESENTER	No disclosure on file
Brenda L. Banwell, MD, FAAN (Johns Hopkins University)	Dr. Banwell has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Banwell has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. Dr. Banwell has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Banwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Banwell has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Banwell has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Banwell has received research support from National MS Society. The institution of Dr. Banwell has received research support from NIH.
E. Ann Yeh, MD, MA, FRCPC (Hospital for Sick Children)	Dr. Yeh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pipeline therapeutics. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Yeh has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for SCN. Dr. Yeh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Yeh has received research support from CIHR. The institution of Dr. Yeh has received research support from National MS Society. The institution of Dr. Yeh has received research support from SickKids Foundation. The institution of Dr. Yeh has received research support from MSSC. The institution of Dr. Yeh has received research support from Garry Hurvitz Foundation. The institution of Dr. Yeh has received research support from Leong Centre. The institution of Dr. Yeh has received research support from OMSLife. The institution of Dr. Yeh has received research support from Canada's Drug Agency. Dr. Yeh has received personal compensation in the range of $0-$499 for serving as a Author with Medscape. Dr. Yeh has a non-compensated relationship as a Editorial Board with Neurology that is relevant to AAN interests or activities. Dr. Yeh has a non-compensated relationship as a Editorial Board with MSJ that is relevant to AAN interests or activities.
Pierre Fayad, MD, FAHA, FAAN (University of Nebraska Medical Center)	Dr. Fayad has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Fayad has received personal compensation in the range of $0-$499 for serving as a Member Data Safety & Monitoring Committee with NINDS.

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