Variable response to therapeutic plasma exchange in pediatric anti-NMDA receptor encephalitis.
INTRODUCTION
Anti-NMDA receptor encephalitis in an acute form generally presents with abnormal movements and psychiatric symptoms. Therapeutic plasma exchange has been considered to be one of the first line treatment options. This report highlights the role of plasma exchange in anti-NMDA receptor encephalitis in pediatric patients.


METHODS
This is a retrospective analysis of four cases of a severe form of encephalitis due to anti-NMDA receptor antibody. All these four patients were evaluated for clinical and laboratory profile before plasma exchange. Plasma exchange was performed with Cobe Spectra Version 7.0(Terumo BCT, USA), and 5% albumin and fresh frozen plasma were used as replacement fluid.


RESULTS
A total of 20 procedures (range: 2-8/patient) were performed on four patients on an alternate day basis. Slow recovery and long-term hospitalization (range: 25-70 days) was observed in all these patients and may be due to delayed initiation of plasma exchange. One patient was lost in follow up while another one had fatal consequences after one month of discharge from the hospital.


CONCLUSION
Early diagnosis and timely initiation of therapeutic plasma exchange along with immunosuppressive therapy hasten the recovery, duration of hospitalization and yield a better outcome.
['Naik|Archana|A|', 'Prakash|Satya|S|', 'Ray|Gopal Krushna|GK|', 'Mukherjee|Somnath|S|']
D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis D002648:Child D006801:Humans D010951:Plasma Exchange D010956:Plasmapheresis D016194:Receptors, N-Methyl-D-Aspartate D012189:Retrospective Studies
Therapeutic plasma exchange Encephalitis Anti-N-methyl-D-aspartate receptor