Plasmapheresis for refractory status epilepticus, part I: A scoping systematic review of the adult literature. (December 2016)

• Record Type: Journal Article
• Authors: Zeiler, F.A.; Matuszczak, M.; Teitelbaum, J.; Kazina, C.J.; Gillman, L.M.
• Is Part Of: Seizure. Volume 43(2016)
• Page Start: 14
• Page End: 22
• Publication Date: 2016-12
• Subjects: Plasmapheresis -- PLEX -- Plasma exchange -- Status epilepticus -- Refractory seizures -- Adults; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2016.10.012
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: 22 original articles met the inclusion/exclusion criteria, with 27 patients treated. 14 of 27 patients (51.9%) responded to plasmapheresis therapy. 3.7% and 48.1% patients displayed partial and complete responses respectively. There is Oxford level 4, GRADE D evidence for plasmapheresis in adult RSE. Abstract: Purpose: Our goal was to perform a scoping systematic review of the literature on the use of plasmapheresis or plasma exchange (PE) for refractory status epilepticus (RSE) in adults. Methods: Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to May 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Twenty-two original articles were identified. Twenty-seven adult patients were described in these articles, with a variety of autoimmune conditions leading to RSE. Seizure response with the application of PE therapy occurred in 14 of the 27 patients (51.9%), with 1 (3.7%) and 13 (48.1%) displaying partial and complete responses respectively. Generalized RSE was the most likely seizure subtype to respond to PE therapy. One patient had recorded an adverse events related to PE therapy. Conclusions: Oxford level 4, GRADE D evidence exists to suggest an uncertain response of adult autoimmune RSE to PE therapy. Thus, the routine application of PE therapy for adult autoimmune RSE cannot be recommended at this time.