Journal article Open Access

Plasmapheresis versus intravenous immunoglobulins administration in the treatment of Guillain Barre' syndrome. Risks and benefits of early treatment – Update data from literature and case report

Assoc. Prof. Mihaela Lungu; Assist. Prof. Violeta Sapira

Guillain Barré syndrome is an acute demyelinating polyneuropathy with an allegedly immune mediated mechanism. The therapeutic options for this condition include intravenous administration of immunoglobulins or plasmapheresis, both of which prove to be safe and effective. To improve prognosis, the neurologist may be tempted to apply one of the two therapies in the early stages of the disease which, according to some authors, may increase the risk of relapse. We report a case of a patient with Guillain Barré syndrome, hospitalized in our clinic, where plasmapheresis treatment was initiated on the 7th day after the onset of the disease. Favorable progression after 6 sessions of plasmapheresis complicated after 4 days from the last procedure with a relapse, requiring resumption of treatment. That is why we chose 6 doses of intravenous immunoglobulins that improved the symptoms, but unfortunately 3 days after the last dose a new episode of worsening motor deficit reappeared. Plasmapheresis was restarted with 4 cures which improved the symptomatology. The numerous relapses have created a discomfort for both the patient and the attending physician and have involved increased treatment costs. We can interpret these relapses either by setting to early a treatment or by having a very active and persistent immune process.

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