master's thesis
Therapeutic plasma exchange in the treatment of the acute disseminated encephalomyelitis

Biljana Ćoso Mihajlović (2016)
Sveučilište u Zagrebu
Medicinski fakultet
KATEDRA ZA INFEKTOLOGIJU
Metadata
TitlePrimjena plazmafereze u liječenju akutnog diseminiranog encefalomijelitisa
AuthorBiljana Ćoso Mihajlović
Mentor(s)Marija Santini (thesis advisor)
Abstract
Akutni diseminirani encefalomijelitis (ADEM) je teška, najčešće monofazična imunološki posredovana demijelinizacijska bolest središnjeg živčanog sustava koja uglavnom pogađa osobe mlađe životne dobi. Liječi se imunomodulacijom, koja se provodi glukokorirtikoidima, plazmaferezom i intravenskim imunoglobulinima. Do danas nema jasnih smjernica za liječenje, a dokazi o učinkovitosti plazmafereze uglavnom se temelje na kratkim serijama i pojedinačnim prikazima bolesnika. Cilj ovog retrospektivnog opservacijskog istraživanja je prikazati seriju bolesnika s ADEM-om liječenih u Zavodu za intenzivnu medicinu i neuroinfektolgiju Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu, od 1.1.2006. do 30.7.2016. U promatranom periodu liječeno je 9 bolesnika čiji je medijan dobi iznosio 25 godina (minimum 20, maksimum 42 godine). Modificirana Rankinova skala (MRS) na početku liječenja iznosila je u 6 od 9 bolesnika 5 (varirala je od 2 do 5). U svih bolesnika je primjenjena plazmfereza (PF). Do povlačenja simptoma je došlo u pet od devet bolesnika nakon 3 procedure PF. Medijan MRS kod otpusta iznosio je 2 (minimum 3, maksimum 1). Na temelju brzine povlačenja znakova i simptoma nakon primjene PF, te na temelju konačanog poboljšanja stanja bolesnika izraženog putem MRS može se zaključiti da je PF koristan oblik imunomodulacijskog liječenja, ali da su za određivanje optimalnog vremena i režima primjene potrebne prospektivne kontrolirane kliničke studije.
KeywordsADEM plasmapheresis corticosteroids therapy
Parallel title (English)Therapeutic plasma exchange in the treatment of the acute disseminated encephalomyelitis
Committee MembersDalibor Vukelić (committee chairperson)
Goran Tešović (committee member)
Marija Santini (committee member)
GranterSveučilište u Zagrebu
Medicinski fakultet
Lower level organizational unitsKATEDRA ZA INFEKTOLOGIJU
PlaceZagreb
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Infectology
Study programme typeuniversity
Study levelgraduate
Study programmeStudies in Nursing
Academic title abbreviationmag. med. techn.
Genremaster's thesis
Language Croatian
Defense date2016-09-20
Parallel abstract (English)
Acute disseminated encephalomyelitis (ADEM) is a severe, mostly monophasic central nervous system (CNS) immune mediated demyelinating disease, primarily affecting young patients. Immunomodulating treatment options include glucocorticoids, plasmapheresis (PF) and intravenous immunoglobulins, but there are no clear guidelines for their administration. The evidence for the effectiveness of plasmapheresis is mainly based on case series and individual case reports. The aim of this retrospective observational study is to present ADEM case series treated at the Department of Intensive Care and Neuroinfections of the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic ", Zagreb, from January 1, 2006 to June 30, 2016. In the observed period nine patients were treated whose median age was 25 (minimum 20, maximum 42). The modified Rankin Scale in six of nine patients was 5 (minimum 5, maximum 2). All patients were treated by plasmapheresis (PF). In five of nine patients the improvement was noticed after 3 procedures of PF. Median MRS at discharge was 2 (minimum 3, maximum 1). According to the dynamics of improvement after PF and according to the final treatment outcomes we can conclude that PF is a useful form of immunomodulatory ADEM treatment. But, for its’ timing and optimal regimen prospective controlled clinical studies are needed.
Parallel keywords (Croatian)ADEM plazmafereza kortikosteroidi liječenje
Resource typetext
Access conditionOpen access
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:105:788724
CommitterLovela Machala Poplašen