Gait Disturbance and Reduced Lower Limb Reflexes in an Adolescent: Positive Impact of Therapeutic Plasmapheresis

The parents of a 15-year-old boy were referred to the Yeolyan Hematology and Oncology Center by a neurologist due to a marked decrease in sensation in the lower extremities, numbness, and tingling. The disease course was characterized by progressive muscle weakness, which gradually ascended from the limbs upward. Symptoms were symmetrical, affecting both extremities simultaneously, resulting in significant gait disturbance and markedly diminished reflexes.

Diagnosis

The patient was diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Pharmacologic treatment was initially administered; however, the desired clinical response was not achieved. Therapeutic plasmapheresis was subsequently indicated by the neurologist, as it is considered a first-line treatment for this diagnosis.

In CIDP, the myelin sheath surrounding nerve fibers is damaged, disrupting the transmission of signals from the brain to the muscles.

Through apheresis-based plasmapheresis, plasma containing pathogenic antibodies that damage the nervous system is removed from the patient’s blood. The purified blood is then returned to circulation, helping halt further myelin destruction.

A total of 10 therapeutic plasmapheresis sessions were performed, followed by pharmacologic treatment.

Significant positive clinical improvement was observed during plasmapheresis, and by the completion of treatment, symptoms had nearly resolved. As a result:

The progression of the disease was halted,

lower limb sensation was restored,

Motor activity and gait significantly improved.

Therapeutic plasmapheresis is considered a first-line treatment modality in a range of diseases.