Plasma exchange in pediatric central nervous system inflammatory demyelination
Bibliographic record
Abstract
Aims: Evaluation of the clinical features and treatment response to plasma exchange (PLEX) in children with severe inflammatory central nervous system (CNS) demyelination. PLEX has been described in steroid refractory CNS inflammatory demyelination in adults, but few are known in children with CNS inflammatory demyelination. Methods: Retrospective review of prospectively collected data from 409 consecutive children presenting at a tertiary pediatric hospital between 1999 and 2012. Included were all children who were treated with PLEX for an inflammatory CNS demyelination. Written informed consent was obtained. Case report forms, charts, and MRI scans were reviewed. Level of disability was scored using the expanded disability status scale (EDSS) and evaluated at PLEX start, at discharge and at 3 months after PLEX. Results: About 12 patients (9 female) who were receiving PLEX were identified (average age 12 years, range 7 to 18 years). Diagnosis was acute transverse myelitis in 6/12, relapsing-remitting multiple sclerosis in 5/12, and ADEM in 1/12. Index attack leading to PLEX was symptomatic cord lesions in 10/12 and symptomatic brainstem lesions in 2/12. Therapy preceding PLEX included methylprednisolone in 7/12, IVIG in 1/12, methylprednisolone and IVIG in 2/12. About 2/12 received PLEX as initial therapy. Median time from symptom onset to PLEX was 6 days (range 1 to 24). Median EDSS at PLEX start was 7.25 (range 4 to 9.5). Three children experienced: hypersensitivity reaction (1), anemia necessitating transfusion (1), thrombosis (1), and hypotension necessitating intravenous fluids (2). Median time from PLEX start to discharge was 15 days (range 9 to 88). Median EDSS at discharge was 5.75 (range 2 to 9.5) and at 3 months 4 (range 0 to 8.5). At 3 months, 7/12 had an EDSS of < 4. Conclusion: We describe our experience with PLEX in children with severe CNS demyelination. Side effects necessitating intervention were observed in 25%. Over half of the children in this series regained independent ambulation 3 months after PLEX. Given the retrospective nature and small cohort, prospective studies in larger pediatric cohorts are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".