Plasmapheresis treatment in Guillain-Barré syndrome: potential benefit over IVIg in patients with axonal involvement.

Response to therapeutic plasma exchange (TPE) was evaluated in patients diagnosed with Guillain-Barré Syndrome (GBS). Our aim was to assess response to TPE in patients who had failed treatment with intravenous immune globulin (IVIg). We conducted a retrospective chart review of 10 patients with the diagnosis of Guillain-Barré Syndrome who required TPE. Patients were identified by reviewing data from log books for TPE at The University of Connecticut Health Center, Farmington CT, USA. Patients who had failed IVIg treatment prior to being referred for TPE were also identified. Eight out of 10 patients treated with TPE showed improvement in their neurological exam. Four patients had axonal involvement on electromyelogram (EMG). Three patients were referred for TPE after failing IVIg treatment. All three of these had axonal involvement on EMG. Three of the four patients with axonal involvement demonstrated improvement with TPE. TPE may be a superior treatment option as compared to IVIg in patients with GBS and EMG findings of axonal involvement.