Plasmapheresis for refractory status epilepticus, part I: a scoping systematic review of the adult literature

Clinician Investigator Program, University of Manitoba, Winnipeg, Canada; Section of Neurosurgery, University of Manitoba, Winnipeg, Canada; Undergraduate Medicine, University of Manitoba, Winnipeg, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Critical Care Medicine, Dept. of Medicine, University of Manitoba, Winnipeg, Canada; Section of General Surgery, Dept. of Surgery, University of Manitoba, Winnipeg, Canada.

Seizure. 2016;43:14-22.
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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.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine