Kinetics of anti-peripheral nerve myelin antibody in patients with Guillain-Barre syndrome treated and not treated with plasmapheresis
F. J. Vriesendorp, R. F. Mayer and C. L. Koski
Department of Neurology, University of Maryland School of Medicine, Baltimore.
Serial anti-peripheral nerve myelin antibody titers were determined in 28
consecutive patients with Guillain-Barre syndrome during the course of
their illness. Eighteen patients were treated with plasmapheresis and 10
were not. Anti-peripheral nerve myelin antibody titers in the group treated
with plasmapheresis declined significantly more rapidly than in the group
not treated with plasmapheresis. Five patients treated with plasmapheresis
who showed initial clinical improvement, with a concurrent decline in
anti-peripheral nerve myelin antibody titer, had one or two recurrences of
clinical symptoms during a 2- to 8-week period associated with an increase
in anti-peripheral nerve myelin antibody titer. Recurrent weakness was
severe enough to prompt additional courses of plasmapheresis. The data
suggest that serial determinations of antiperipheral nerve myelin antibody
in patients with Guillain-Barre syndrome may identify patients with
antibody rebound associated with recurrence of clinical symptoms and
prolonged recovery in whom further plasmapheresis should be considered.
