Plasma Exchange for Guillain-Barré Syndrome

Hôpital Raymond Poincaré, Garches, France.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 07/2012; 7(7):CD001798. DOI: 10.1002/14651858.CD001798.pub2
Source: PubMed


Guillain-Barré syndrome is a rare but serious disease of the peripheral nerves (nerves outside the central nervous system) that causes paralysis. Many patients have had a recent chest or stomach infection that may cause an allergic response in the nerves. Autoimmune factors such as antibodies are thought to cause the disease, so plasma exchange is used to treat Guillain-Barré syndrome. Plasma exchange aims to remove these antibodies from the blood stream and replace them with artificial plasma, usually albumin. This review of six randomised controlled trials involving 649 participants found that plasma exchange helps speed recovery from Guillain-Barré syndrome. It is more beneficial when started within seven days of the disease onset. No new trials have been done since the first publication of this review.

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    • "Active immune modulation with IvIg [61] or plasma exchange [62] is the mainstay of treatment with IvIg being preferred in most circumstances due to ease of availability and greater safety in patients with unstable blood pressure and pulse. IvIg is usually given at a dose of 0.4 gm/kg for 5 days although the optimum dose has never been established. "
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    ABSTRACT: Guillain-Barré syndrome (GBS) was first described in 1916 (Guillain G, 1916) and is approaching its 100th anniversary. Our knowledge of the syndrome has hugely expanded since that time. Once originally considered to be only demyelinating in pathology we now recognise both axonal and demyelinating subtypes. Numerous triggering or antecedent events including infections are recognised and GBS is considered an immunological response to these. GBS is now considered to be a clinical syndrome of an acute inflammatory neuropathy encompassing a number of subtypes with evidence of different immunological mechanisms. Some of these are clearly understood while others remain to be fully elucidated. Complement fixing antibodies against peripheral nerve gangliosides alone and in combination are increasingly recognised as an important mechanism of nerve damage. New antibodies against other nerve antigens such as neurofascin have been recently described. Research databases have been set up to look at factors associated with prognosis and the influence of intravenous immunoglobulin (IvIg) pharmacokinetics in therapy. Exciting new studies are in progress to examine a possible role for complement inhibition in the treatment of the syndrome.
    01/2014; 2014(3):793024. DOI:10.1155/2014/793024
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    • "Meanwhile, the cerebrospinal fluid (CSF) of GBS patients usually shows characteristic albumin-cytological dissociation, that is, elevated protein levels and approximately normal cell counts, from two weeks after the disease onset [2]. There is strong evidence proving that both humoral and cellular immune mechanisms are involved in the pathogenesis of GBS: (i) serum antibodies to various gangliosides in human peripheral nerves have been found in about half of GBS patients [3]; (ii) pathological findings in GBS include lymphocytic infiltration in spinal roots and peripheral nerves, followed by macrophage-mediated, multifocal stripping of myelin [4]; (iii) plasma exchange (PE) and intravenous immunoglobulin (IVIg) therapies are effective in the treatment of GBS patients [5] [6]. However, the exact immunological mechanism of GBS remains not understood. "
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    ABSTRACT: Guillain-Barré syndrome (GBS) is an acute autoimmune-mediated inflammatory demyelinating disease that causes rapidly progressing paralysis and occasionally respiratory failure. We hypothesized that interleukin (IL)-17 and IL-22 are elevated in GBS and participate in the autoimmune inflammatory response of GBS. We used sandwich enzyme-linked immunosorbent assay (ELISA) to measure the IL-17 and IL-22 levels in the CSF, and plasma from 22 GBS patients at the acute phase and 18 healthy controls (HC). The results show that CSF and plasma levels of IL-17 and IL-22 are elevated in GBS patients compared with HC. IL-17 and IL-22 levels in CSF, respectively, are correlated with GBS disability scale scores (GDSs). Meanwhile, IL-17 and IL-22 levels in CSF, IL-22 in CSF, and plasma of GBS patients have positive correlation, respectively. The increased levels of IL-17 and IL-22 in CSF may be explained by the disruption of blood-brain barrier (BBB) and peripheral nervous system (PNS) local inflammation in GBS. Meanwhile, the elevated levels of these two cytokines in plasma suggest the activation of Th17 and Th22 cells in the systemic immune response of GBS. Our data provide preliminary evidence that GBS is associated with high levels of IL-17 and IL-22 in CSF and plasma. These cytokines display pathogenic potential and may serve as useful biomarkers for GBS.
    Mediators of Inflammation 10/2012; 2012:260473. DOI:10.1155/2012/260473 · 3.24 Impact Factor
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    • "We observed maximum benefit in patients with AIDP/GBS and MG with an overall response rate of 93.2% and 81.8%, respectively which is comparable to other studies [20] [21]. TPE is more beneficial when applied within the first week of disease, although it is still effective when performed within the first month [22]. At our center we also had similar experiences as more treatment failures were encountered when the patients were referred late in the course of their disease. "
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    ABSTRACT: We present here our experience with therapeutic apheresis (TA) performed for various indications, clinical response and complications in a tertiary care center over last 10 years. Present study is a retrospective analysis of 492 TA procedures performed for 125 patients from January 2000 to December 2009. For each patient: age, gender, weight, clinical indication, pre-procedure hematological profile and ionized calcium levels were recorded. For every procedure following parameters were analyzed: type of venous access (central/peripheral), volume of blood and plasma processed, amount of anticoagulant used, procedure duration, blood flow rate, type of replacement fluid given, response to therapy and adverse reactions. Of 492 TA procedures, 68.8% were performed for neurology, 20.8% hematology-oncology, 9.6% renal and 0.8% for rheumatology patients. Therapeutic plasma exchanges (n=464; 94.3%) and therapeutic cytapheresis (n=28; 6.7%) were performed in 113 and 12 patients, respectively. Majority of patients belonged to ASFA category I and II (n=124; 99.2%). The overall response rate was 84%, with encouraging response in TTP (100%), aHUS (81.8%) and in neurological disorders (88.4%). Adverse events were reported in 52.8% of patients in 14.83% of procedures. Our results of TPE in neurological disorders and in atypical hemolytic uremic syndrome are encouraging and it is a cost effective alternative to IvIg in neurological disorders. Currently, there is a need for establishment of an Indian apheresis registry to understand the scenario of TA across the country and in the expansion of appropriate and applicable indications for TA in our setting.
    Transfusion and Apheresis Science 12/2011; 45(3):239-45. DOI:10.1016/j.transci.2011.09.002 · 0.77 Impact Factor
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