Plasmapheresis associated with a relapsing course in Guillain-Barré syndrome

An 11-year-old boy with severe Guillain-Barré syndrome underwent 2 courses of 5 plasmaphereses. During each course his strength and respiratory function improved. Within 3 days of completing each course, his deficits worsened. After a prolonged plateau following the second course of plasmapheresis, he spontaneously improved and continues to recover gradually 11 months following the onset of symptoms. Plasmapheresis appeared to produce a fluctuating course in our patient. Prior to the availability of effective therapeutic intervention for Guillain-Barré syndrome, a natural course, characterized by recurrence of symptoms, predicted poorer recovery. Fluctuations related to plasmapheresis may not carry similar implications; the clinician should consider this phenomenon in assessing prognosis.