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Introduction: Early recognition of immune-mediated encephalopathies is fundamental given that the entities are rapidly progressive and potentially reversible with adequate treatment.   Immunomodulatory treatment, however, may not be completely effective. The aim of this study was to assess the impact of therapeutic plasma exchange (TPE) in children withimmune-mediated encephalopathies and a partial response to immunomodulatory treatment.  Methods: A retrospective study was conducted over the period 2011-2012. Immune-mediated encephalopathy was defined according to clinical and ancillary study criteria.TPE was performed in patients with persistent symptoms in spite of immunomodulatory treatment. The modified Rankin Scale (mRS) (0-6) was used at onset, immediate pre- and post-treatment, and at the last visit to  assess clinical outcome. Data were analyzed with the Wilcoxon test. Results: Seven of 18 children, with ages ranging from 4 to 14 years, underwent TPE.  Three patients were positive for Anti-NMDA antibodies. Time between disease onset and TPE ranged from 18 to 180 days. The initial mRS score was 5 in all patients. A post-TPE decrease of the score of 1 to 2 points was found(p=0.011). Symptoms improved after the third TPE procedure and after day 9. Adverse events observed were hypocalcemia and catheter-related complications. Conclusions: The present study shows the efficacy of TPE as a therapeutic option in children withimmune-mediated encephalopathies with a partial response to immunomodulatory treatment, even in those with chronic disease.

therapeutic plasma exchange; immune-mediated encephalopathy; children