Guillain-Barré syndrome treated by membrane plasma exchange and/or immunoadsorption

In this report, we evaluate the success of immunoadsorption and plasma membrane exchange treatment in patients with severe Guillain-Barré syndrome (GBS), and describe one case successfully treated by immunoadsorption after failure of plasma exchange therapy. Nineteen severely paralyzed GBS patients, aged 14-76 years, who were treated between 1998 and 2008, were retrospectively studied. They underwent 161 immunoadsorption and 119 plasma exchange procedures. In severe GBS, 4-30 immunoadsorption and 5-31 plasma exchange sessions were needed. Among 16 patients on mechanical ventilation, 11 recovered from disability completely, while in one patient mild muscle weakness persisted after one year. One patient suffered from ischemic stroke, two patients died after weaning from mechanical ventilation. One death was believed to be procedure-unrelated, the other patient died from sepsis. Four patients were lost to follow-up. We treated a 14-year-old, mechanically-ventilated patient using two different apheresis methods. After failure of 31 membrane plasma exchanges over 34 days, the patient was then switched to the immunoadsorption apheresis method, receiving seven sessions in 15 days. He no longer required assisted ventilation and recovered from the disability completely. A high number of immunoadsorption as well as membrane plasma exchange treatments can be safely and effectively applied in severe GBS patients. Our patients often needed, and were provided with, more than the currently arbitrarily accepted four apheresis sessions before good clinical recovery was achieved. For non-responders to plasma exchange treatment, immunoadsorption may be the first-line therapy.