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A Case Report of Plasmapheresis in the Treatment of Acute Disseminated Encephalomyelitis
Author(s) -
Shinozaki Koichiro,
Oda Shigeto,
Sadahiro Tomohito,
Nakamura Masataka,
Abe Ryuzo,
Nakamura Shiho,
Hattori Noriyuki,
Hirano Shigeki,
Hattori Takamichi,
Hirasawa Hiroyuki
Publication year - 2008
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2008.00617.x
Subject(s) - plasmapheresis , medicine , acute disseminated encephalomyelitis , corticosteroid , intracranial pressure monitoring , intracranial pressure , neurology , surgery , anesthesia , disease , pediatrics , immunology , antibody , psychiatry
Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system associated with significant morbidity and mortality. High‐dose corticosteroid administration has been considered the mainstay of treatment for ADEM; however, some patients with ADEM are refractory to steroid therapy. We report a case of a 17‐year‐old man suffering from ADEM who did not respond to corticosteroid therapy, but who exhibited a dramatic recovery with plasmapheresis. He became comatose, requiring ventilatory support, and exhibited abnormalities of some brainstem reflexes prior to treatment. He underwent sequential courses of plasma exchange therapy for three days. Plasma exchanges were carried out with concomitant continuous hemodiafiltration (CHDF) to control intracranial pressure by stabilizing pH, plasma Na + concentration, and colloid osmotic pressure. After plasma exchanges, his reflexes and level of consciousness gradually improved. Eleven months after this treatment, he had only minimal neurological deficit that did not interfere with any of his activities of daily living. The efficacy of plasmapheresis for ADEM has not yet been established. Plasmapheresis may be indicated for ADEM, not only for patients with severe disease in whom high‐dose corticosteroid treatment has failed, but also as first‐line treatment for ADEM. Early initiation of plasmapheresis appears to be associated with moderate to marked improvement. Early recognition and early treatment of ADEM are thus of paramount importance.