Beneficial effect of plasma exchange in unrecovered cases of acute Guillian Barre Syndrome
Gharib Fawi*and Ola Ahmed Shawky**, neuropsychiatry departments, faculty of medicine Sohag*, and Assiut** universities
Abstract
Objectives: the present study was designed to determine whether plasma exchange has a beneficial effect on the course and outcome of unrecovered severe cases of acute Guillian- Barre Syndrome (GBS) if started two months or more after onset of the disease. The predictors of poor outcome in those patients were also analyzed.
Methods: twenty patients with onset of acute Guillian Barre Syndrome of tow months or more were selected in the study. All patients fulfilled the criteria required for diagnosis of acute Guillian Barre syndrome, either clinical, laboratory or neurophysiological criteria. All patients of the study were subjected to three to five sessions of plasma exchange throughout 2-4 weeks. Serial clinical and neurophysiological assessments were done for each patient.
Results: the following predictors of poor outcome were detected in our study:
Older age of patients at onset of the disease, severe rapidly progressive paralysis within 4 days of the onset, presence of preceding prodroma of gastrointestinal or upper respiratory tract infections, presence of papilloedema, increased CSF protein >1gm/dl, impairment of neurophysiological parameters (Severely reduced compound motor action potential, severely reduced motor nerve conduction velocity, severely prolonged distal motor latency).
-Outcome after plasma pharesis:
* No improvement in three patients (15%).
*Seventeen patients (85%) developed improvement as follows:
Ten patients (50%) get complete improvement, three patients (15%) get mild improvement, and four patients (20%) get moderate improvement.
The clinical improvement was parallel with improvement in the neurophysiological parameters.
Conclusion:
In those patients with unrecovered sever cases of acute Guillian Barre Syndrome in whom plasma exchange had never been used before, even after long period of onset of the disease, plasma exchange must be tried where good results were reported in our study. There are several predictors of poor outcome in-patients with acute Guillian Barre Syndrome must be put in mind for prognostic and therapeutic concepts