[Treatment of Guillain-Barré syndrome with "axonal" involvement by plasma exchange]

A 19-year-old man with Guillain-Barré syndrome (GBS), who had been bedridden, dramatically improved after plasma exchange despite electrophysiological evidence of severe axonal damage. We commenced the therapy at 24 days after the onset of illness. Each trial of plasma exchange improved the strength clinically and rapidly increased the amplitude of the compound muscle action potential. Four months later, muscle strength recovered to normal except for mild weakness of the distal limb muscles. The time course of such a prompt recovery precludes axonal regeneration as its underlying mechanism in our patient. We postulate that some humoral factor might have reversibly depressed the axonal excitability, causing clinical symptoms which mimic axonal degeneration. Plasma exchange is a choice of treatment even for patients with GBS showing electrophysiological findings suggestive of axonal involvement.