Limited relapse in Guillain-Barré syndrome after plasma exchange

Ten of 94 consecutive patients with acute Guillain-Barré syndrome treated with plasma exchange relapsed after initial improvement. Deterioration occurred five to 42 days after the first series of exchanges, was usually mild, and in eight re-treated patients, responded to a second series of plasma exchanges. None developed chronic inflammatory demyelinating polyneuropathy. The initial exchanges began three to 22 days (mean, 11 days and ended 14 to 27 days (mean, 19 days after the onset of illness. The biphasic course on these patients with limited relapses suggests that plasma exchange removes a circulating factor that continues to be active if treatment is stopped too early. Re-treatment with a second, and sometimes a third, series of plasma exchanges may be affective.