March 2019 Vol. 7 No.3

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Original Research Article

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^1* and Assist. Prof. Violeta Sapira²

¹Head of Neurological Department, Emergency Clinical Hospital Galati, Romania; Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Romania
²Neurological Department, Emergency Clinical Hospital Galati, Romania; Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Romania

*Corresponding Author’s E-mail: mihaelalungu17@yahoo.com micalungu@gmail.com
Phone: +40724365046

Accepted March 19, 2019

Abstract

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.

Keyword: Guillain Barré syndrome, plasmapheresis, immunoglobulins, relapse