[Treatment of anti-glycolipid antibody-associated neuropathy]

The therapeutic effect of plasma exchange in Guillain-Barré syndrome (GBS) is related to the removal of circulating factors. Plasma concentrations of interleukin and other cytokines are elevated in GBS, but because their circulating half-lives are only a few hours, the effect of plasma exchange on their plasma levels would be short term. In contrast, the half-life of IgG is 3 weeks, much longer than that of other plasma proteins. This indicates that IgG is the most important factor in the development of GBS. Results of a large clinical study suggest that 2 exchanges are sufficient for mild cases of GBS, and for all others 4 exchanges are optimal. We showed that a significant IgG decrease was obtained in the first 2 sessions. Our result supports that at least 2 exchanges are needed for treating GBS. In Japan, patients with GBS often receive not only plasma exchange but also double-filtration plasmapheresis or immunoadsorption. We compared their abilities to remove immunoglobulins and anti-ganglioside antibodies. Plasma exchange decreased the IgG concentration much more than double-filtration plasmapheresis. The ability to remove IgG anti-ganglioside antibodies in plasma exchange was significantly superior to that of the other plasmaphereses.