AI tool use, self-efficacy, foreign language enjoyment, and willingness to communicate: a moderated serial mediation model among Chinese EFL learners.

Neurological disorders encompass a wide spectrum of conditions, including both autoimmune and non-autoimmune etiologies. Autoimmune neurological disorders occur when the immune system erroneously targets components of the nervous system, whereas non-autoimmune disorders may result from vascular, metabolic, infectious, or other pathological processes (). Therapeutic plasma exchange (TPE) has been utilized as a treatment modality across this spectrum and is thought to exert its therapeutic effects through the removal of circulating pathogenic autoantibodies, immune complexes, and other plasma constituents that may contribute to disease pathology (). Plasmapheresis refers to the separation and removal of plasma from whole blood (). Therapeutic plasma exchange, in contrast, involves not only removal but also replacement of plasma with appropriate humoral components. Despite these technical distinctions, the literature often uses the terms interchangeably (). The burden of immune-mediated neurological disorders, including myasthenia gravis (MG), autoimmune encephalitis (AE), Guillain–Barré syndrome (GBS), multiple sclerosis (MS), and neuromyelitis optica spectrum disorder (NMOSD), has increased globally and regionally (). To guide clinical decision-making, standardized recommendations have been established for the use of TPE across various neurological conditions. According to the American Society for Apheresis (ASFA) 2023 guidelines, TPE indications are categorized into four groups: Category I includes first-line indications such as GBS, MG, NMDA receptor encephalitis, and chronic inflammatory demyelinating polyneuropathy (CIDP). Category II encompasses conditions like acute disseminated encephalomyelitis, MS, and NMOSD, where TPE may serve as a second-line option (). Category III includes diseases like crescentic IgA nephropathy, where the role of TPE is uncertain and should be individualized. In Category IV, TPE is generally not recommended due to lack of benefit or potential harm, as in thrombotic microangiopathy (, ). While TPE is widely accepted as a therapeutic option (), some literature has raised concerns regarding its safety and complications. Afzali et al. () highlighted the need for caution, particularly with central vascular access. Reported complications include allergic reactions, fluid shifts, cardiovascular instability, and infections related to vascular access. Hypocalcemia is among the most common adverse effects due to citrate anticoagulants used in the apheresis circuit (, ). In addition, intravenous immunoglobulin (IVIG) is used as a first-line or adjunctive therapy in several immune-mediated neurological disorders. Previous studies have reported comparable efficacy between IVIG and TPE in selected conditions (, ). For example, in Guillain–Barré syndrome, both IVIG and TPE are recommended treatment options according to the current European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) guidelines. However, the role and effectiveness of these therapies vary across neurological disorders depending on disease characteristics, severity, and clinical context (). Given the limited regional data and the clinical variability in outcomes, further investigation is warranted. Therefore, this study aims to assess the functional outcomes associated with TPE in patients with selected neurological disorders at NGHA in Jeddah, Saudi Arabia.