Nöropsikiyatri Arşivi; 2014;51(1):63-68
Nörolojik Hastalıklarda Terapötik Plazma Değişimi: 91 Hasta ile Yedi Yıllık Deneyim Sonuçları
S Karaca, İ Kozanoğlu, BK Göksel, M Karataş, M Tan, VD Yerdelen, S Giray, Z Arlıer
Başkent University, Adana
Introduction: In this study, we report the results of our experience of therapeutic
plasma exchange (TPE) for neuroimmunologic disorders performed at our hospital
over a seven-year period.
Methods:
We retrospectively reviewed the medical records of 91 patients (53
male, 38 female) who had been treated at our center with TPE.
Results:
60 patients with Guillain-Barrè syndrome (GBS), 23 with myasthenia
gravis (MG), 4 with chronic inflammatory demyelinating polyneuropathy (CIDP)
and 1 patient each with polymyositis, septic encephalopathy, acute disseminated
encephalomyelitis (ADEM) and Opsoclonus-Myoclonus syndrome (OMS) received
TPE. 26.7% of GBS patient’s made complete recovery, 61.7% had partial recovery
and 11.7% patients died due to respiratory failure. Despite our best efforts and
effective TPE treatments, 13.4% of MG patients deceased, however, 78% had full
recovery. Three patients with CIDP were discharged with full and 1 patient with
partial recovery. The patient with ADEM had partial recovery with TPE at first,
but deceased 2 months later due to pneumonia-related respiratory insufficiency.
While, patient with polymyositis had slight-partial recovery, we obtained
full recovery with TPE in septic encephalopathy and OMS patients. The side
effects and complications of treatments with TPE, which included hypotension,
hypocalcaemia and anemia, were mild and manageable.
Conclusion:
The improvement rates were encouraging and we concluded
that significant benefit can be achieved with TPE for the treatment of
neuroimmunological disorders.
Therapeutic Plasma Exchange in Neurologic Diseases: An Experience with 91 Patients in Seven Years
Giris: Bu çalismada, terapötik plazma degisimi (TPD) ile tedavi ettigimiz nöroimmünolojik
olgulara ait 7 yillik deneyimimizin sonuçlari rapor edilmistir.
Yöntem:
TPD uyguladigimiz 91 olgunun (53 erkek, 38 kadin) medikal kayitlari
geriye dönük olarak incelenmistir.
Bulgular:
Tanisal olarak siniflandiginda, bu olgularin 60’inin Guillain-
Barre sendromu (GBS), 23’ünün Miyastenia Gravis (MG), 4’ünün ise kronik
inflammatuar demiyelinizan polinöropati (KIDP) tanisiyla TPD aldigi
görülmüstür. Birer olguya ise, polimiyozit, septik ensefalopati, akut dissemine
ensefalomiyelit (ADEM) ve Opsoklonus-Myoklonus sendromu (OMS) tanilariyla
TPD uygulanmistir.
GBS hastalarimizin %26,7’sinde tam düzelme, %61,7’sinde kismi düzelme
izlenmis olup, disabilitesi yüksek %11,7 hasta solunum yetmezligi nedeniyle
kaybedilmistir. MG’li hastalarin %13,4’ünde tedaviye ragmen ölüm, %78’inde
tam klinik düzelme gözlenmistir. KIDP’li 4 hastamizin üçünde total, birinde
kismi düzelme gözlenmis, ADEM’li olgumuz TPD ile önce kismen düzelmis
ancak tedaviden 2 ay sonra aspirasyon pnömonisine bagli solunum yetmezligi
nedeniyle kaybedilmis, polimiyozitli olgumuzda kismi, septik ensefalopati
ve OMS’li hastalarimizda tam düzelme gözlenmistir. TPE uygulamasinda
karsilastigimiz yan etkiler hipotansiyon, hipokalsemi ve anemi gibi hafif ve
yönetilebilir düzeydedir.
Sonuç:
Çalismamizin sonuçlari otoimmün kökenli nörolojik hastaliklarda
TPE tedavisinin etkili ve güvenilir bir yöntem oldugunu göstermektedir