Therapeutic Plasma Exchange: An Indispensable Therapy for Severe Neurological Condition

Bălaşa, Rodica

doi:10.2478/jccm-2020-0021

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Other favorable data for the use of TPE are represented by a study conducted in Southern India and published in 2014, which compared the two treatments and did not show a significant difference between the two groups in terms of improvement rate, but found that IVIg costs more (USD 4250-5300) compared to plasmapheresis (USD 2600-4100) (55). These data are similar to that reported by Western European countries (56)(57)(58); therefore, plasmapheresis could be the preferred method for treating GBS in low-socioeconomic countries.…”

Section: Discussionsupporting

confidence: 89%

Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

et al. 2021

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Guillain-Barré syndrome is an acute immune-mediated disease that affects the peripheral nervous system, with progressive motor deficit in the limbs, sometimes involvement of the cranial nerves and possible impairment of the autonomic nervous system. Due to the respiratory and autonomic nervous dysfunction, the disease has the potential to be fatal. Although modern methods of treatment have significantly improved patient prognosis, many patients nevertheless experience significant neurological sequelae. The practical applicability of plasmapheresis was illustrated in our case report. We report the case of a 27-year-old man who had a mild viral respiratory tract infection 1 week prior to the onset of disease with gradual development of a motor deficit, urinary retention, slight swallowing difficulties and mild respiratory dysfunction. Nerve conduction studies were performed and the diagnosis of acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome was established. Autoimmune and inflammatory diseases, infectious diseases, endocrinopathies, neoplastic diseases, intoxications, metabolic diseases and vitamin deficiencies were ruled out. Our patient attended four sessions of therapeutic plasma exchange performed using peripheral venous approach with two needles with significant recovery of the motor deficit. The patient was discharged 1 week later on maintenance kinetotherapy with further favorable evolution. In conclusion, we report a good evolution as a result of therapeutic plasma exchange in a patient with acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome. The procedure is well-tolerated and can be performed safely by peripheral approach not only in the intensive care unit but also in a neurology clinic.

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Section: Discussionsupporting

confidence: 89%

Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

et al. 2021

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“…IVIg is a blood product with antibacterial and antiviral broad-spectrum activity that has been used before in the treatment of autoimmune and inflammatory disease such as autoimmune thrombocytopenic purpura, GBS, myasthenia gravis or severe bacterial and viral infections for more than 30 years (129,133,(139)(140)(141)(142). In the previous outburst of SARS and MERS, IVIg was well-tolerated and showed clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

High‑dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS‑CoV‑2 infection: A case‑based review of the literature (Review)

et al. 2021

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The still ongoing COVID-19 pandemic has exposed the medical community to a number of major challenges. A significant number of patients require admission to intensive care unit (ICU) services due to severe respiratory, thrombotic and septic complications and require long-term hospitalization. Neuromuscular weakness is a common complication in critically ill patients who are treated in ICUs and are mechanically ventilated. This complication is frequently caused by critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) and leads to difficulty in weaning from the ventilator. It is thought to represent an important neurologic manifestation of the systemic inflammatory response syndrome (SIRS). COVID-19 infection is known to trigger strong immune dysregulation, with an intense cytokine storm, as a result, the frequency of CIP is expected to be higher in this setting. The mainstay in the diagnosis of this entity beside the high level of clinical awareness is the electrophysiological examination that provides evidence of axonal motor and sensory polyneuropathy. The present article presents the case of a 54-year-old woman with severe COVID 19 infection who developed neuromuscular weakness, which turned out to be secondary to CIP and was treated successfully with a high dose of human intravenous

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“…Associated GBS to COVID-19 treatment consisted mainly of intravenous immunoglobulins (IVIg) and therapeutic plasma exchange (TPE) according to previous guidelines and reports ( 6 , 7 , 48 ), to which various antiviral treatment regimens have been associated and in some cases ICU support. The improvement was partial but not in all cases, 62% had relief of symptoms in the short term as identified by Uncini et al ( 39 ).…”

Section: Characteristics Of Patients With Covid-19 and Gbsmentioning

confidence: 99%

Guillain‑Barré syndrome associated with Covid‑19: A close relationship or just a coincidence? (Review)

et al. 2021

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Several neurological complications affecting the central and peripheral nervous system were described secondary to COVID-19 infection such as hyposmia, headache, nausea, impaired consciousness, psychosis, neurocognitive syndromes and even cerebrovascular accidents. The mechanism of these complications is not fully understood, but heterogenous mechanisms such as cytokine storm, secondary hypercoagulability and direct neurotropism of the virus are thought to be involved. Guillain-Barré syndrome is a heterogeneous disease that frequently follows a bacterial or viral infection. During the ongoing SARS-CoV-2 pandemic, several isolated case reports and case series have suggested an association between this viral infection and the occurrence of Guillain-Barré syndrome. The main mechanism of Guillain-Barré syndrome is probably post-viral dysregulation of the immune system generated by SARS-CoV-2. The clinical characteristics and disease evolution seem to be similar to those observed in Guillain-Barré syndrome secondary to other etiologies. The aim of the present review is to summarize the relevant literature regarding SARS-CoV-2-related Guillain-Barré syndrome.

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Therapeutic Plasma Exchange: An Indispensable Therapy for Severe Neurological Condition

Cited by 4 publications

References 17 publications

Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

High‑dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS‑CoV‑2 infection: A case‑based review of the literature (Review)

Guillain‑Barré syndrome associated with Covid‑19: A close relationship or just a coincidence? (Review)

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