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Introduction: Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region. Method: A questionnaire‐based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center. Results: A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add‐on treatment in steroid‐refractory cases or as first‐line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post‐TPE relapse rates, and TPE‐related complications. The major challenges within our region are expense, reimbursibility, and access to TPE. Conclusion: Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future. [ABSTRACT FROM AUTHOR]

Objective: One of the objectives of the Intersectoral Global Action Plan on epilepsy and other neurological disorders for 2022 to 2031 is to ensure at least 80% of people with epilepsy (PWE) will have access to appropriate, affordable, and safe antiseizure medications (ASMs) by 2031. However, ASM affordability is a significant issue in low‐ and middle‐income countries, preventing PWE from accessing optimal treatment. This study aimed to determine the affordability of the newer (second and third generation) ASMs in resource‐limited countries in Asia. Methods: We conducted a cross‐sectional survey by contacting country representatives in lower‐middle‐income countries (LMICs) in Asia, including Indonesia, Lao People's Democratic Republic (PDR), Myanmar, Philippines, Vietnam, India, Bangladesh, and Pakistan, and the upper‐middle‐income country Malaysia, from March 2022 to April 2022. The affordability of each ASM was calculated by dividing the 30‐day ASM cost by the daily wage of the lowest paid unskilled laborers. Treatment costing 1 day's wage or less for a 30‐day supply of chronic disease is considered affordable. Results: Eight LMICs and one upper‐middle‐income country were included in this study. Lao PDR had no newer ASM, and Vietnam had only three newer ASMs. The most frequently available ASMs were levetiracetam, topiramate, and lamotrigine, and the least frequently available was lacosamide. The majority of the newer ASMs were unaffordable, with the median number of days' wages for a 30‐day supply ranging from 5.6 to 14.8 days. Significance: All new generation ASMs, whether original or generic brands, were unaffordable in most Asian LMICs. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to study the profile of Guillain‐Barré syndrome (GBS) patients admitted at Yangon General Hospital (YGH), Myanmar. Methods: Patients with flaccid quadriparesis due to GBS admitted to the Department of Neurology, YGH in 2019 were prospectively studied. Results: Ninety‐four GBS patients were recruited. Mean age was 36.2 years. Male to female ratio was 2.4:1. Patients were admitted 12.1 ± 14.8 days after disease onset. 46.8% were from outside the Yangon region. Peak incidence was in rainy season (47.9%). 62.8% reported symptoms suggestive of preceding infection: 45.7% unspecified fever, 3.2% upper respiratory infection, 8.5% diarrhea, and 5.3% fever with rash. 27.7% had bulbar and 44.7% had facial weakness. 5.3% had GBS/Miller Fisher syndrome overlap. Electrophysiologically, 50% were acute inflammatory demyelinating polyneuropathy (AIDP), 30% acute motor axonal neuropathy (AMAN), and 20% acute motor‐sensory axonal neuropathy (AMSAN). Maximum disability was reached at 5.6 ± 4.78 days from onset. The plateau phase lasted 12.12 ± 14.27 days. 13.8% required ventilator support. 64.9% of patients received limited manual plasma exchange, 9.6% standard plasma exchange, 4.3% intravenous immunoglobulin and 21.3% no specific treatment. 79.8% had good clinical recovery at 4 weeks from inclusion. Mortality was 0%. Severity at admission was identified as the only poor recovery predictor. Conclusion: Guillain‐Barré syndrome in a Yangon tertiary hospital peaked in rainy season and axonal GBS accounted for 50% cases. However, diarrhea was an uncommon antecedent. The good recovery was noted in 79.8% and largely predicted by severity of disease at admission. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an increasingly important role within the Southeast Asian (SEA) region. The South East Asian Therapeutic Plasma exchange Consortium (SEATPEC) was formed in 2018 to promote education and research on TPE within the region. The advent of the Covid‐19 pandemic has produced challenges for the development and expansion of this service. Methodology: A qualitative and semi‐quantitative questionnaire‐based survey was conducted by SEATPEC member countries from January to June 2020 (Phase 1) and then from July 2020 to January 2021 in (Phase 2) to assess the impact of Covid‐19 on regional TPE. Objectives: The study's main objectives were to explore the challenges experienced and adaptations/adjustments taken by SEATPEC countries in order to continue safe and efficient TPE during the Covid‐19 pandemic. Results: The pandemic was found to disrupt the delivery of TPE services in all SEATPEC countries. Contributing factors were multifactorial due to overstretched medical services, staff shortages, quarantines and redeployments, fear of acquiring Covid‐19, movement restriction orders, and patient's psychological fear of attending hospitals/testing for Covid‐19. All SEATPEC countries practiced careful stratification of cases for TPE (electives vs emergencies, Covid‐19 vs non‐Covid‐19 cases). SEATPEC countries had to modify TPE treatment protocols to include careful preprocedure screening of patient's for Covid‐19, use of personal protective equipment (PPE) and post‐TPE sanitization of machines and TPE suites. Conclusion: Based on the responses of the survey, SEATPEC countries produced a consensus statement with five recommendations for safe and effective TPE within the region. [ABSTRACT FROM AUTHOR]

Therapeutic plasma exchange (TPE) is an effective and affordable treatment option in most parts of Southeast Asia (SEA). In 2018, the SEA TPE Consortium (SEATPEC) was established, consisting of regional neurologists working to improve outcome of various autoimmune neurological diseases. We proposed an immunotherapeutic guideline prioritizing TPE for this region. We reviewed disease burden, evidence-based treatment options, and major guidelines for common autoimmune neurological disorders seen in SEA. A modified treatment algorithm based on consensus agreement by key-opinion leaders was proposed. Autoimmune antibody diagnostic testing through collaboration with accredited laboratories was established. Choice of first-line immunotherapies (IVIg/corticosteroid/TPE) is based on available evidence, clinicians' experience, contraindications, local availability, and affordability. TPE could be chosen as first-line therapy for GBS, CIDP, MG (acute/short term), IgG, A paraproteinemic neuropathy, and NMDAR encephalitis. Treatment is stopped for acute monophasic conditions such as GBS and ADEM following satisfactory outcome. For chronic immune disorders, a therapy taper or long-term maintenance therapy is recommended depending on the defined clinical state. TPE as second-line treatment is indicated for IVIg or corticosteroids refractory cases of ADEM, NMOSD (acute), MG, and NMDAR/LGI1/CASPR2/Hashimoto's encephalitis. With better diagnosis, treatment initiation with TPE is a sustainable and effective immunotherapy for autoimmune neurological diseases in SEA. [ABSTRACT FROM AUTHOR]

A 66 years‐old lady presented with acute onset confusion and status epilepticus. MRI (Brain) showed T2 shine through at bilateral hippocampi. Cerebrospinal fluid revealed mild lymphocytic pleocytosis. Screening for infections, autoimmune and paraneoplastic conditions were negative except significantly high anti‐TPO antibody and hyperthyroid state. Her seizures needed multiple antiepileptic drugs. Limbic encephalitis was treated with high‐dose steroid but not responded and plasma exchange was proceeded. At two weeks after plasma exchange, her conscious level and seizure frequency were significantly improved. We present a case of Hashimoto's encephalopathy presenting with limbic encephalitis not responding to steroid but to plasma exchange. [ABSTRACT FROM AUTHOR]

A 44‐year‐old man with end‐stage renal disease on regular hemodialysis presented with fever, loose motion, and confusion followed by coma. Screening for systemic infections was negative. MRI (Brain) showed multiple T2/FLAIR hyperintensities in the bilateral periventricular/subcortical regions involving corpus callosum and right cerebral peduncle with some restricted diffusions without abnormal enhancement suggestive of acute disseminated encephalomyelitis. Cerebrospinal fluid examination revealed normal protein, mildly reduced sugar and no pleocytosis but culture was Sphingomonas paucimobilis positive. Anti‐MOG antibody was negative. He was treated with antibiotics according to sensitivity and high dose steroid. At one and a half month after steroid initiation, he has significantly improved to Glasgow Coma Scale 15. Brain MRI rechecked at 3 months showed significant improvement with no recurrence. Here, we report a rare case of Sphingomonas paucimobilis meningitis complicated with acute disseminated encephalomyelitis. [ABSTRACT FROM AUTHOR]

In conjunction with the third regional Southeast Asian (SEA) therapeutic plasma exchange (TPE) conference in Kuala Lumpur, Malaysia, 25 clinicians and researchers from SEA and South Asian countries attended the inaugural strategy meeting for the establishment of a regional TPE consortium for neurological disorders. The primary objective was to establish regional collaboration to improve delivery of TPE services in SEA. A pre‐meeting survey was conducted to gather insights on disease spectrum, contextual practice challenges, and the need for a regional TPE consensus. Challenges identified include limited healthcare funding in support of diagnostic workup, TPE therapy, as well as development of clinical infrastructure and expertise capacity building. There was favorable interest in developing a working plan contextualized to this region. Strategies to overcome challenges were discussed. This included the need for a comprehensive referral system and network of regional TPE centers suited to local needs, supported by innovative TPE delivery programs. [ABSTRACT FROM AUTHOR]

In December 2017, 79 delegates attended the 2nd regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders in Kuala Lumpur, Malaysia. This meeting featured 6 plenary lectures, interactive sessions dedicated for experience sharing, case presentations, and a practical session for paramedics. Clinical experts and researchers from 7 SEA countries and India shared experience and challenges in treating autoimmune neurological disorders. While the spectrum of diseases and neurology practice remained largely similar, there was great disparities in accessibility of therapeutic plasma exchange (TPE) within SEA countries and between urban or rural settings. Costs, human resources, and healthcare policies are common challenges in providing sustainable TPE services. Novel techniques and innovative ideas in performing TPE were explored. A working consortium comprising of key opinion leaders was proposed to improve standards of TPE and enhance future research. [ABSTRACT FROM AUTHOR]