Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas

Introducción: Las enfermedades inflamatorias inmunomediadas del sistema nervioso central en la población pediátrica, como la encefalitis autoinmune, encefalomielitis aguda diseminada y síndrome de Guillain-Barré, presentan desafíos diagnósticos y terapéuticos. La terapia de recambio plasmático ha su...

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Autores:: Rodríguez Galeano, Andrés Felipe
Ruge Joya, Erika Johanna

Tipo de recurso:: https://purl.org/coar/resource_type/c_7a1f

Fecha de publicación:: 2025

Institución:: Universidad El Bosque

Repositorio:: Repositorio U. El Bosque

Idioma:: spa

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repository_id_str
dc.title.none.fl_str_mv	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
dc.title.translated.none.fl_str_mv	PLASMA EXCHANGE THERAPY IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES OF THE CENTRAL NERVOUS SYSTEM.
title	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
spellingShingle	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas Encefalitis autoinmune Encefalomielitis aguda diseminada Síndrome de Guillain-Barré Recambio terapéutico de plasm Aféresis Autoimmune Encephalitis Acute Disseminated Encephalomyelitis Guillain-Barré Syndrome Therapeutic Plasma Exchange Apheresis WS205
title_short	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
title_full	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
title_fullStr	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
title_full_unstemmed	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
title_sort	Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas
dc.creator.fl_str_mv	Rodríguez Galeano, Andrés Felipe Ruge Joya, Erika Johanna
dc.contributor.advisor.none.fl_str_mv	Bravo Guerra, Diana Lucía
dc.contributor.author.none.fl_str_mv	Rodríguez Galeano, Andrés Felipe Ruge Joya, Erika Johanna
dc.contributor.orcid.none.fl_str_mv	Rodríguez Galeano, Andrés Felipe (0009-0001-5654-9460)
dc.subject.none.fl_str_mv	Encefalitis autoinmune Encefalomielitis aguda diseminada Síndrome de Guillain-Barré Recambio terapéutico de plasm Aféresis
topic	Encefalitis autoinmune Encefalomielitis aguda diseminada Síndrome de Guillain-Barré Recambio terapéutico de plasm Aféresis Autoimmune Encephalitis Acute Disseminated Encephalomyelitis Guillain-Barré Syndrome Therapeutic Plasma Exchange Apheresis WS205
dc.subject.keywords.none.fl_str_mv	Autoimmune Encephalitis Acute Disseminated Encephalomyelitis Guillain-Barré Syndrome Therapeutic Plasma Exchange Apheresis
dc.subject.nlm.none.fl_str_mv	WS205
description	Introducción: Las enfermedades inflamatorias inmunomediadas del sistema nervioso central en la población pediátrica, como la encefalitis autoinmune, encefalomielitis aguda diseminada y síndrome de Guillain-Barré, presentan desafíos diagnósticos y terapéuticos. La terapia de recambio plasmático ha surgido como una opción útil en casos refractarios. Este estudio evaluó la respuesta clínica a la TRP en niños con estas patologías. Metodología: Estudio de cohorte retrospectiva realizado en la Fundación Hospital Pediátrico La Misericordia, Bogotá (2018–2022), que incluyó a 50 pacientes menores de 18 años con diagnóstico confirmado de enfermedad inflamatoria del sistema nervioso central mediada por anticuerpos y tratados con terapia de recambio plasmático. Se recolectaron variables clínicas, terapéuticas y desenlaces, y se aplicaron análisis descriptivos, de supervivencia y modelos de regresión de Cox. Resultados: La edad media fue de 10 años, con distribución equitativa por sexo. Las patologías más frecuentes fueron encefalitis autoinmune (36 %) y encefalomielitis aguda diseminada (14 %). El 56 % de los pacientes persistió con síntomas neurológicos al egreso; 46 % recuperó su funcionalidad previa. La mortalidad fue del 6 %. El uso de anticonvulsivantes se asoció significativamente con menor riesgo de recaída (HR 0,081; p = 0,024), y el uso de esteroides con una mayor supervivencia, especialmente en encefalitis autoinmune, encefalomielitis aguda diseminada y miastenia gravis (p < 0,05). Conclusión: La terapia de recambio plasmático es una estrategia terapéutica viable y segura en niños con enfermedades inflamatorias del sistema nervioso central inmunomediadas. El uso concomitante de anticonvulsivantes y esteroides mostró beneficios en la reducción de recaídas y mortalidad.
publishDate	2025
dc.date.accessioned.none.fl_str_mv	2025-07-16T16:01:46Z
dc.date.available.none.fl_str_mv	2025-07-16T16:01:46Z
dc.date.issued.none.fl_str_mv	2025-06
dc.type.coar.fl_str_mv	http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv	Tesis/Trabajo de grado - Monografía - Especialización
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dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/bachelorThesis
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dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12495/14974
dc.identifier.instname.spa.fl_str_mv	instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv	repourl:https://repositorio.unbosque.edu.co
url	https://hdl.handle.net/20.500.12495/14974
identifier_str_mv	instname:Universidad El Bosque reponame:Repositorio Institucional Universidad El Bosque repourl:https://repositorio.unbosque.edu.co
dc.language.iso.fl_str_mv	spa
language	spa
dc.relation.references.none.fl_str_mv	Mühlhausen J, Kitze B, Huppke P, Müller GA, Koziolek MJ. Apheresis in treatment of acute inflammatory demyelinating disorders. Atheroscler Suppl. 2015;18:251-256. doi:10.1016/j.atherosclerosissup.2015.02.037. Linker RA, Chan A, Sommer M, et al. Plasma exchange therapy for steroidrefractory superimposed relapses in secondary progressive multiple sclerosis. J Neurol. 2007;254(9):1288-1289. doi:10.1007/s00415-006-0497-0. Chou IJ, Whitehouse WP, Wang HS, Tanasescu R, Constantinescu CS. Diagnostic modalities in multiple sclerosis: perspectives in children. Biomed J. 2014;37(2):50-59. doi:10.4103/2319-4170.129269. Khair AM. Utility of Plasmapheresis in Autoimmune-Mediated Encephalopathy in Children: Potentials and Challenges. Neurol Res Int. 2016;2016:7685807. doi:10.1155/2016/7685807. Hardy D. Autoimmune Encephalitis in Children. Pediatr Neurol. 2022;132:56-66. doi:10.1016/j.pediatrneurol.2022.05.004. Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN. Sindrom Giiena—Barre u detei [Guillain-Barre syndrome in children]. Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(9. Vyp. 2):20-32. doi:10.17116/jnevro202312309220. Korinthenberg R. Acute polyradiculoneuritis: Guillain-Barré syndrome. Handb Clin Neurol. 2013;112:1157-1162. doi:10.1016/B978-0-444-52910-7.00036-2. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397(10280):1214-1228. doi:10.1016/S0140-6736(21)00517-1. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-EvidenceBased Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher. 2016 Jun;31(3):149-62. Clark WF, Huang SS, Walsh MW, Farah M, Hildebrand AM, Sontrop JM. Plasmapheresis for the treatment of kidney diseases. Kidney Int. 2016;90(5):974-984. doi:10.1016/j.kint.2016.06.009. Fernández-Zarzoso M, Gómez-Seguí I, de la Rubia J. Therapeutic plasma exchange: Review of current indications. Transfus Apher Sci. 2019;58(3):247-253. doi:10.1016/j.transci.2019.04.007. Daga Ruiz D, Fonseca San Miguel F, González de Molina FJ, Úbeda-Iglesias A, Navas Pérez A, Jannone Forés R. Plasmapheresis and other extracorporeal filtration techniques in critical patients. Med Intensiva. 2017;41(3):174-187. doi:10.1016/j.medin.2016.10.005. Woźniak K, Urbanowska E, Snarski E. Plazmafereza lecznicza w hematologii [Plasmapheresis in haematology]. Wiad Lek. 2015;68(2):173-178. Bauer PR, Ostermann M, Russell L, et al. Plasma exchange in the intensive care unit: a narrative review. Intensive Care Med. 2022;48(10):1382-1396. doi:10.1007/s00134-022-06793-z. Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol. 2014;164(3):342-351. doi:10.1111/bjh.12629. Pusey CD, Levy JB. Plasmapheresis in immunologic renal disease. Blood Purif. 2012;33(1-3):190-198. doi:10.1159/000334155. Cervantes CE, Bloch EM, Sperati CJ. Therapeutic Plasma Exchange: Core Curriculum 2023. Am J Kidney Dis. 2023;81(4):475-492. doi:10.1053/j.ajkd.2022.10.017. Hafer C, Golla P, Gericke M, et al. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. Int Urol Nephrol. 2016;48(1):133-138. h. Kes P, Janssens ME, Basic-Jukic N, Kljak M. A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures. Transfusion. 2016;56(12):3065-3072. Nakanishi T, Suzuki N, Kuragano T, Nagasawa Y, Hasuike Y. Current topics in therapeutic plasmapheresis. Clin Exp Nephrol. 2014;18(1):41-49. doi:10.1007/s10157-013-0838-0. Mineshima M, Akiba T. Double filtration plasmapheresis in critical care. TherApher. 2002;6:180–3. Mineshima M. Double filtration plasmapheresis: Determination of the optimal albumin concentration in the supplementation fluid. Transfus Apher Sci. 2017;56(5):654-656. doi:10.1016/j.transci.2017.08.009. Hirata N, Kuriyama T, Yamawaki N. Immusorba TR and PH. Ther Apher Dial. 2003;7:85–90. Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis. 2008 Dec;52(6):1180-96. Nguyen TC, Kiss JE, Goldman JR, Carcillo JA. The role of plasmapheresis incritical illness. Crit Care Clin. 2012;28(3):453-vii. doi:10.1016/j.ccc.2012.04.009. Querol L, Lleixà C. Novel Immunological and Therapeutic Insights in GuillainBarré Syndrome and CIDP. Neurotherapeutics. 2021;18(4):2222-2235. Dop D, Marcu IR, Padureanu R, Niculescu CE, Padureanu V. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Review). Exp Ther Med. 2021;21(1):94. doi:10.3892/etm.2020.9526. Vreeland A, Thienemann M, Cunningham M, Muscal E, Pittenger C, Frankovich J. Neuroinflammation in Obsessive-Compulsive Disorder: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, and Pediatric Acute Onset Neuropsychiatric Syndrome. Psychiatr Clin North Am. 2023;46(1):69-88. doi:10.1016/j.psc.2022.11.004. Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidencebased guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011;76(3):294-300. doi:10.1212/WNL.0b013e318207b1f6. Kaynar L, Altuntas F, Aydogdu I, et al. Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Transfus Apher Sci. 2008;38(2):109–115. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology. 2002;58(1):143–146. Chung A, Deimling M. Guillain-Barré Syndrome. Pediatr Rev. 2018;39(1):53-54. doi:10.1542/pir.2017-0189. Korinthenberg R, Trollmann R, Felderhoff-Müser U, et al. Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol. 2020;25:5-16. doi:10.1016/j.ejpn.2020.01.003. Kim YA, Sloan SR. Pediatric therapeutic apheresis: rationale and indications for plasmapheresis, cytapheresis, extracorporeal photopheresis, and LDL apheresis. Pediatr Clin North Am. 2013;60(6):1569-1580. doi:10.1016/j.pcl.2013.08.006. Sotgiu S, Onida I, Magli G, et al. Juvenile Chronic Inflammatory Demyelinating Polyneuropathy Epidemiology in Sardinia, Insular Italy. Neuropediatrics. 2021;52(1):56-61. doi:10.1055/s-0040-1715626. Vanasse M, Rossignol E, Hadad E. Chronic inflammatory demyelinating polyneuropathy. Handb Clin Neurol. 2013;112:1163-1169. doi:10.1016/B978-0-444- 52910-7.00037-4. Arroyo HA. Tratamiento de la miastenia gravis juvenil [Treatment of juvenile myasthenia gravis]. Medicina (B Aires). 2019;79 Suppl 3:71-76. Peragallo JH. Pediatric Myasthenia Gravis. Semin Pediatr Neurol. 2017;24(2):116-121. doi:10.1016/j.spen.2017.04.003. Chiang LM, Darras BT, Kang PB. Juvenile myasthenia gravis. Muscle Nerve. 2009;39(4):423-431. doi:10.1002/mus.21195. Gold LS, Suh K, Schepman PB, Damal K, Hansen RN. Healthcare Costs and Resource Utilization in Patients with Multiple Sclerosis Relapses Treated with H.P. Acthar Gel(®). Adv Ther. 2016;33(8):1279-1292. doi:10.1007/s12325-016-0363-0. López-Benítez J, Castillo Rocha PA, Hon KLE, Mohanty M, Torres AR. Opciones terapéuticas para enfermedades neurológicas autoinmunes en pediatría [Pediatric therapeutic options in autoimmune neurologic diseases]. Medicina (B Aires). 2022;82 Suppl 3:62-66. Cantarín-Extremera V, Jiménez-Legido M, Sebastián-Pérez E, Duat-Rodríguez A, Ruiz-Falcó Rojas ML. Inmunoadsorción y plasmaféresis: ¿posibilidades de tratamiento en la encefalitis de Rasmussen? [Immunoadsorption and plasmapheresis: possible treatments for Rasmussen’s encephalitis?]. Rev Neurol. 2020;70(4):159-160. doi:10.33588/rn.7004.2019439. Counce D, Limdi N, Kuzniecky R. Rasmussen’s Encephalitis. Curr Treat Options Neurol. 2001;3(6):555-563. doi:10.1007/s11940-001-0018-5. Sergent SR, Ashurst JV. Plasmapheresis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 10, 2023. de Bruijn MAAM, Bruijstens AL, Bastiaansen AEM, et al. Pediatric autoimmune encephalitis: Recognition and diagnosis. Neurol Neuroimmunol Neuroinflamm. 2020;7(3):e682. Published 2020 Feb 11. https://doi.org/10.1212/NXI.0000000000000682. Sen S, Kumar A, Roy B. Clinical Outcome of Guillain-Barré Syndrome in 108 Children. Indian Pediatr. 2021;58(9):833-835. https://doi.org/10.1007/s13312-021- 2302-7. Fraga MM, de Oliveira EML, Len CA, Campos MF, Terreri MT. Devic’s disease in an adolescent girl with juvenile dermatomyositis. Rev Bras Reumatol Engl Ed. 2017;57(5):475-478. https://doi.org/10.1016/j.rbre.2014.12.004. Gokce G, Ceylan OM, Mutlu FM, Altinsoy HI, Koylu T. Relapsing Devic’s disease in a child. J Pediatr Neurosci. 2013;8(2):146-149. https://doi.org/10.4103/1817- 1745.117852. Wang CX. Assessment and Management of Acute Disseminated Encephalomyelitis (ADEM) in the Pediatric Patient. Paediatr Drugs. 2021;23(3):213- 221. https://doi.org/10.1007/s40272-021-00441-7. Ipe TS, Meyer EK, Sanford KW, Joshi SK, Wong ECC, Raval JS. Use of therapeutic plasma exchange for pediatric neurological diseases. J Clin Apher. 2021;36(1):161-176. https://doi.org/10.1002/jca.21850. Eyre M, Hacohen Y, Barton C, Hemingway C, Lim M. Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm. Dev Med Child Neurol. 2018;60(8):765-779. https://doi.org/10.1111/dmcn.13925. Michon B, Moghrabi A, Winikoff R, et al. Complications of apheresis in children. Transfusion. 2007;47(10):1837-1842. https://doi.org/10.1111/j.1537- 2995.2007.01405.x. Paglialonga F, Schmitt CP, Shroff R, et al. Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. Pediatr Nephrol. 2015;30(1):103-111. https://doi.org/10.1007/s00467-014-2907-3. Du J, Guo Y, Zhu Q. Use of anti-seizure medications in different types of autoimmune encephalitis: A narrative review. Front Neurol. 2023;14:1111384. https://doi.org/10.3389/fneur.2023.1111384. Nosadini M, Thomas T, Eyre M, et al. International Consensus Recommendations for the Treatment of Pediatric NMDAR Antibody Encephalitis. Neurol Neuroimmunol Neuroinflamm. 2021;8(5):e1052. Published 2021 Jul 22. https://doi.org/10.1212/NXI.0000000000001052. Gadian J, Kirk E, Holliday K, Lim M, Absoud M. Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders. Dev Med Child Neurol. 2017;59(2):136-144. doi:10.1111/dmcn.13349.
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spelling	Bravo Guerra, Diana LucíaRodríguez Galeano, Andrés FelipeRuge Joya, Erika JohannaRodríguez Galeano, Andrés Felipe (0009-0001-5654-9460)2025-07-16T16:01:46Z2025-07-16T16:01:46Z2025-06https://hdl.handle.net/20.500.12495/14974instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coIntroducción: Las enfermedades inflamatorias inmunomediadas del sistema nervioso central en la población pediátrica, como la encefalitis autoinmune, encefalomielitis aguda diseminada y síndrome de Guillain-Barré, presentan desafíos diagnósticos y terapéuticos. La terapia de recambio plasmático ha surgido como una opción útil en casos refractarios. Este estudio evaluó la respuesta clínica a la TRP en niños con estas patologías. Metodología: Estudio de cohorte retrospectiva realizado en la Fundación Hospital Pediátrico La Misericordia, Bogotá (2018–2022), que incluyó a 50 pacientes menores de 18 años con diagnóstico confirmado de enfermedad inflamatoria del sistema nervioso central mediada por anticuerpos y tratados con terapia de recambio plasmático. Se recolectaron variables clínicas, terapéuticas y desenlaces, y se aplicaron análisis descriptivos, de supervivencia y modelos de regresión de Cox. Resultados: La edad media fue de 10 años, con distribución equitativa por sexo. Las patologías más frecuentes fueron encefalitis autoinmune (36 %) y encefalomielitis aguda diseminada (14 %). El 56 % de los pacientes persistió con síntomas neurológicos al egreso; 46 % recuperó su funcionalidad previa. La mortalidad fue del 6 %. El uso de anticonvulsivantes se asoció significativamente con menor riesgo de recaída (HR 0,081; p = 0,024), y el uso de esteroides con una mayor supervivencia, especialmente en encefalitis autoinmune, encefalomielitis aguda diseminada y miastenia gravis (p < 0,05). Conclusión: La terapia de recambio plasmático es una estrategia terapéutica viable y segura en niños con enfermedades inflamatorias del sistema nervioso central inmunomediadas. El uso concomitante de anticonvulsivantes y esteroides mostró beneficios en la reducción de recaídas y mortalidad.Hospital Pediátrico La Misericordia HOMIEspecialista en Medicina Crítica y Cuidado Intensivo PediátricoEspecializaciónIntroduction: Immune-mediated inflammatory diseases of the central nervous system in the pediatric population, such as autoimmune encephalitis, acute disseminated encephalomyelitis, and Guillain-Barré syndrome, present diagnostic and therapeutic challenges. Plasma exchange therapy has emerged as a useful option in refractory cases. This study evaluated the clinical response to plasma exchange therapy in children with these conditions. Methods: A retrospective cohort study was conducted at Fundación Hospital Pediátrico La Misericordia in Bogotá (2018–2022), including 50 patients under 18 years of age with a confirmed diagnosis of antibody-mediated inflammatory disease of the central nervous system who were treated with plasma exchange therapy. Clinical, therapeutic, and outcome variables were collected, and descriptive, survival, and Cox regression analyses were performed. Results: The mean age was 10 years, with an equal sex distribution. The most common conditions were autoimmune encephalitis (36%) and acute disseminated encephalomyelitis (14%). At discharge, 56% of patients had persistent neurological symptoms; 46% recovered their prior functional status. Mortality was 6%. The use of antiepileptic drugs was significantly associated with a lower risk of relapse (HR 0.081; p = 0.024), and steroid use was associated with increased survival, particularly in autoimmune encephalitis, acute disseminated encephalomyelitis, and myasthenia gravis (p < 0.05). Conclusion: Plasma exchange therapy is a viable and safe therapeutic strategy for children with immune-mediated inflammatory diseases of the central nervous system. The concomitant use of antiepileptic drugs and steroids showed benefits in reducing relapse and mortality.application/pdfEncefalitis autoinmuneEncefalomielitis aguda diseminadaSíndrome de Guillain-BarréRecambio terapéutico de plasmAféresisAutoimmune EncephalitisAcute Disseminated EncephalomyelitisGuillain-Barré SyndromeTherapeutic Plasma ExchangeApheresisWS205Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadasPLASMA EXCHANGE THERAPY IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES OF THE CENTRAL NERVOUS SYSTEM.Especialización en Medicina Crítica y Cuidado Intensivo PediátricoUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aaMühlhausen J, Kitze B, Huppke P, Müller GA, Koziolek MJ. 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Terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas

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