Abstracts

Rationale: Many patients with antibody-mediated neurologic disease present with seizures. For the pediatric population, there are no guidelines on treatment of these disorders, and specifically the role of TPE. This study will add to the dearth of literature on the use of TPE for pediatric neurologic diseases. Methods: After obtaining IRB approval, we performed a retrospective chart review of patients who underwent TPE for a neurologic indication at our institution. Data extracted included: demographic, medical history, seizure occurrence, details of the hospital admission during which TPE was performed (e.g., medications, diagnostic studies, TPE frequency, length of stay, etc.), and follow-up. Categorical variables are described using frequencies and percentages, and continuous variables using medians and ranges. Wilcoxon rank sum test evaluated relationships between seizures and length of hospital stay and neurologic outcome. Results: Between January 2011 and March 2014, 18 patients underwent TPE for neurologic disease. Ten (56%) patients, which make up the cohort preseted here, had suspected antibody-mediated encephalitis. Of those 10 subjects, 7 (70%) were male. The median age at initiation of TPE was 9.2 years (2.6-17.5). The median admission length of stay was 30 days (10-91). The median number of TPE performed was 7 (3-10), with a median volume exchanged of 1.2L per session (0.4-1.3). Six (60%) subjects had seizures as part of their presentation. Seven (70%) subjects were placed on an anti-epileptic drug (AED) during admission, 6 (86%) of whom were discharged on an AED. Six (60%) subjects were placed on a neuroleptic medication during admission, 5 (83%) of whom were discharged on one of the medications. Positive antibodies were found in 6 (60%) of the subjects. Every subject had an EEG performed, of which seven (70%) were abnormal. Of the 6 subjects with a confirmed antibody, 4 (66%) had an abnormal EEG, all of which were characterized by moderate or high voltage delta slow waves. At last follow-up, 3 (30%) subjects had an abnormal neurologic exam, but no patients had residual psychiatric symptoms. Four of the seven (57%) subjects who were discharged on an AED remained on an AED at follow-up, and 2 of the six (33%) subjects who were discharged on a neuroleptic medication remained on it at follow-up. Analysis showed a trend toward a longer hospital stay and seizures, but this was not statistically significant (p>0.05). There was no difference in neurologic exam at follow-up in those with seizures versus no seizures (p>0.05). Conclusions: Given the small number of subjects, it is difficult to assess the relationship between specific diagnoses and outcome. Nonetheless, this study does provide groundwork for future projects to develop optimal management strategies, monitoring plans, and tailored TPE intervention in children with neurologic diseases. Additionally, the findings on EEG in the antibody-positive subgroup, while non-specific, merit more detailed evaluation and could support the use of EEG as a biomarker.