CSF filtration is an effective treatment of Guillain-Barre syndrome - A randomized clinical trial

Objective: To compare CSF filtration (CSFF) and plasma exchange (PE) in the treatment of patients with Guillain-Barre syndrome (GBS). Methods: In a pr ospective controlled clinical trial, 37 patients with acute GBS were random ized to receive either CSFF or PE. Inclusion criteria were fulfillment of N ational Institute of Neurological and Communicative Disorders and Stroke cr iteria and disability to walk >5 m unassisted. Results: With similar baseli ne features in both groups (initial disability grades on the six-point grad ing scale of the GBS Study Group) the primary outcome variable (improvement within 28 days after randomization) was almost identical (test for equival ence p = 0.0014), the mean grade values being 0.82 in the CSFF group and 0. 80 in the PE group. After 56 days, 56% (9 of 16 patients) of the CSFF group and 37% (7 of 19 patients) of the PE group had reached grade 2 (i.e., abil ity of unassisted walking >5 m). After 6 months, the probability to reach g rade 2 was about 80% in both groups. In the CSFF group, transient pleocytos is occurred without apparent clinical complications. Clinically relevant co mplications were higher in the PE-treated group. Conclusions: Although the number of patients was small, the authors found that the treatment of GBS w ith CSFF is at least as effective as with PE. CSFF might work by removing f rom the CSF inflammatory mediators, autoantibodies, or other factors.