Therapeutic Plasma Exchange Effectively Improves Ambulation in Pediatric Transverse Myelitis

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Treatment with TPE was well tolerated in 108 of 114 treatments.
Treatment with TPE was well tolerated in 108 of 114 treatments.

For pediatric patients with transverse myelitis, an inflammatory condition of the spinal cord associated with sensory, autonomic, and motor dysfunction, the use of therapeutic plasma exchange (TPE) is safe and may help improve ambulation, according to a retrospective study published in Neurology: Clinical Practice.

Billing data for pediatric patients with transverse myelitis who underwent TPE were retrospectively reviewed (n=19). All patients received hospital care between 2010 and 2016. Medical charts were used to extract relevant patient data, including data regarding TPE-related adverse events and outcomes. In the cohort, an overall mean 5.9 TPEs were performed every other day. The targeted treatment goal of 1.1 patient plasma volumes was reached in 98% of treatments.

Treatment with TPE was well tolerated in 108 of 114 treatments. Symptoms associated with treatment were limited and spontaneously resolved within 30 minutes of presentation. Approximately 79% (n=15) of patients experienced improvement in transverse myelitis symptoms at discharge, and 32% and 42% of patients required additional inpatient and outpatient physical therapy, respectively. Up to 78% of patients were ambulatory at mean 25-month posthospital follow-up. Additionally, 80% (n=12) of the 15 patients assigned a modified Rankin Scale score at nadir and last follow-up were physically independent for all activities.

A limitation of the analysis is its retrospective nature, which limited the researchers' ability to determine causality between TPE and improvements in pediatric transverse myelitis symptoms.

Whereas TPE was demonstrated to be an effective treatment strategy for acute transverse myelitis in pediatric patients, additional research “studies are indicated to prospectively and on a larger scale characterize which patients may benefit from plasma exchange as part of their transverse myelitis treatment.”

Reference

Noland DK, Greenberg BM. Safety and efficacy of plasma exchange in pediatric transverse myelitis. Neurol Clin Pract. 2018;8(4):1-4.

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