Liquorpheresis (CSF-filtration): An effective treatment in acute and chronic severe autoimmune polyradiculoneuritis (Guillain-Barré syndrome)

Abstract

In recent years, plasmapheresis has become a well established treatment of acute and chronic polyradiculoneuritis (Guillain-Barré syndrome, GBS). Nevertheless, there are still non-responders and there are particular risks associated with this treatment. Despite all efforts, the duration of severe forms of Guillain-Barré syndrome is still considerable. Inflammation and demyelination start intrathecally. We therefore used liquorpheresis (cerebrospinal fluid filtration) as a new effective therapeutic approach. Our first patient, severely disabled with acute GBS, artificially ventilated, had undergone plasma exchange without effect. Plasma immunoadsorption led only to transient improvement. After several liquorphereses, the patient recovered completely. In three additional patients with acute and two with chronic GBS an improvement of clinical signs in close temporal relation to liquorpheresis was observed. Twice, liquorpheresis was combined with immunoadsorption of cerebrospinal fluid. Liquorpheresis was well tolerated in all cases. This procedure may be effective by eliminating humoral or cell-bound factors responsible for the onset or/and maintenance of inflammation. Further controlled studies are necessary and are in progress.

CSF Filtration: Scientific and Clinical Update

“…Several authors have already described that GBS patients in early and even later stages of disease, not responding to plasma exchange and/or high dose intravenous immunoglobulins, draw benefit from CSF filtration (1,6,8,11,12,13,15). Wollin sky et al (8) recently presented clinical data on nine GBS patients suffering from long-term deficits (disease duration on average 20.1 months).…”

“…The filtration of cerebrospinal fluid (CSF) was first used by Wollin sky and coworkers in severely affected GBS patients who did not respond to other therapies (1). Recently published data describing in vitro studies, animal experiments and clinical experience in Ulm, Germany (2-6) encouraged other centres to use this technique.…”

“…Recently published data describing in vitro studies, animal experiments and clinical experience in Ulm, Germany (2-6) encouraged other centres to use this technique. We are actually facing an increase in clinical data on CSF filtration (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) with enlargement of the range of indications as well as an understanding of the possible mechanism of CSF filtration in various neurological diseases (3)(4)(5)(18)(19)(20)(21)(22). Even though it is still an experimental approach more than 40 hospitals -predominantly situated in the German speaking countries -are presently using CSF filtration.…”

Multimodal Therapy in Life-Threatening Cerebral Lupus erythematosus: The Benefit of Cerebrospinal Fluid Pheresis

“…It is conceivable that, similar to Guillain-Barre syn drome [9,10,12,13] or Miller-Fisher syndrome [pers. unpubl.…”

Liquorpheresis (CSF filtration) in familial amyotrophic lateral sclerosis

“…1 ± 3 The therapeutic e ect in these disorders is said to be due to the removal of toxic metabolites, cells, in¯ammatory mediators or antibodies. 2,3 In familial ALS, which accounts for up to 10% of all ALS patients, liquorpheresis has not been applied so far.…”