Limited relapse in Guillain-Barre syndrome after plasma exchange
A. E. Ropper, J. W. Albert and R. Addison
Neurological/Neurosurgical intensive Care Unit, Massachusetts General Hospital, Boston.
Ten of 94 consecutive patients with acute Guillain-Barre syndrome treated
with plasma exchange relapsed after initial improvement. Deterioration
occurred five to 42 days after the first series of exchanges, was usually
mild, and in eight re-treated patients, responded to a second series of
plasma exchanges. None developed chronic inflammatory demyelinating
polyneuropathy. The initial exchanges began three to 22 days (mean, 11 days
and ended 14 to 27 days (mean, 19 days after the onset of illness. The
biphasic course on these patients with limited relapses suggests that
plasma exchange removes a circulating factor that continues to be active if
treatment is stopped too early. Re-treatment with a second, and sometimes a
third, series of plasma exchanges may be affective.
