CHARACTERISTICS OF 73 PATIENTS, 1984-1993, TREATED BY PLASMA-EXCHANGEFOR GUILLAIN-BARRE-SYNDROME

Acute Guillain-Barre syndrome (GBS) is a demyelinating polyneuropathy which responds readily to plasma exchange (PEX). According to the Nort h American Acute GBS PEX study there is a 50% or more reduction in the recovery time if PEX is initiated early in the course of the disease. Demyelinating antibodies are usually IgM. IgA antibodies require prol onged PEX. Patients with predominant IgG antibodies have chronic infla mmatory demyelinating polyneuropathy (CIDP), which requires an even lo nger course of PEX, over weeks to months or years. We reviewed records of 73 patients with the initial diagnosis of GBS treated with PEX. Am ong these patients, 55 had classic GBS, three had the Miller-Fisher va riant, two had CIDP, and 13 had demyelinating-like polyneuropathies as sociated with other conditions including malignancy, vaccine-related m yelitis, steroid-induced myopathy, polymyositis, botulism, gram-negati ve sepsis, Sjogren's, and AIDS. Hughes grading system was used. Patien ts were graded 3 to 5, with grade 3 patients being unable to walk 5 m without support, grade 4 patients being bed or chair bound, and grade 5 patients being ventilator dependent. Of 60 unassociated (GBS) demyel inating cases receiving a mean of 6.5 PEX procedures, 13 (21%) were in tubated early in thr treatment, with four (6%) remaining ventilator de pendent post-PEX. Of 51 non-intubated patients, 15 became ambulatory p ost-PEX. Patients with the Miller-Fisher variant showed improvement wi thin 6 hours of PEX initiation. We did not investigate correlation of GBS with infection; however, we did observe a rise in CMV titer among 15% of the 58 patients with acute GBS. Considering our results we beli eve that intensive PEX on a daily basis for a few days is necessary fo r severely affected individuals. We advise five to nine procedures at consultation unless early, rapid recovery occurs. (C) 1997 Wiley-Liss, Inc.