Therapeutic plasma exchange as a first‑choice therapy for axonal Guillain‑Barré syndrome: A case‑based review of the literature (Review)

Abstract

Guillain-Barré syndrome is an acute immune-mediated disease that affects the peripheral nervous system, with progressive motor deficit in the limbs, sometimes involvement of the cranial nerves and possible impairment of the autonomic nervous system. Due to the respiratory and autonomic nervous dysfunction, the disease has the potential to be fatal. Although modern methods of treatment have significantly improved patient prognosis, many patients nevertheless experience significant neurological sequelae. The practical applicability of plasmapheresis was illustrated in our case report. We report the case of a 27-year-old man who had a mild viral respiratory tract infection 1 week prior to the onset of disease with gradual development of a motor deficit, urinary retention, slight swallowing difficulties and mild respiratory dysfunction. Nerve conduction studies were performed and the diagnosis of acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome was established. Autoimmune and inflammatory diseases, infectious diseases, endocrinopathies, neoplastic diseases, intoxications, metabolic diseases and vitamin deficiencies were ruled out. Our patient attended four sessions of therapeutic plasma exchange performed using peripheral venous approach with two needles with significant recovery of the motor deficit. The patient was discharged 1 week later on maintenance kinetotherapy with further favorable evolution. In conclusion, we report a good evolution as a result of therapeutic plasma exchange in a patient with acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome. The procedure is well-tolerated and can be performed safely by peripheral approach not only in the intensive care unit but also in a neurology clinic.

The Occurrence of Acute Disseminated Encephalomyelitis in SARS-CoV-2 Infection/Vaccination: Our Experience and a Systematic Review of the Literature

“…The response to corticosteroids is favorable in two thirds of cases, and it shortens the duration of the disease and stops further progression. In case of inadequate response, and in refractory cases, therapeutic plasma exchange or IVIg (0.4/kg/body weight) can be recommended according to the protocol applied in other autoimmune neurological diseases [ 12 , 117 , 120 , 121 , 122 ].…”

High‑dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS‑CoV‑2 infection: A case‑based review of the literature (Review)

“…IVIg is a blood product with antibacterial and antiviral broad-spectrum activity that has been used before in the treatment of autoimmune and inflammatory disease such as autoimmune thrombocytopenic purpura, GBS, myasthenia gravis or severe bacterial and viral infections for more than 30 years (129,133,(139)(140)(141)(142). In the previous outburst of SARS and MERS, IVIg was well-tolerated and showed clinical benefits.…”

“…CIP is an axonal polyneuropathy with a length dependent pattern involving both sensory and motor fibers that requires the confirmation of the clinically suspected diagnosis and electrophysiological studies to be performed in order to rule out GBS and CIM, along with EMG or even muscle biopsy ( 128 , 129 ). Sometimes these two entities may coexist ( 19 ).…”

“…The occurrence of CIP and/or CIM associated with COVID-19 must be distinguished from GBS that can also be driven by the SARS-CoV-2 infection ( 67 , 129 , 133 ).…”

“…Muscle biopsy can be used additionally in difficult cases ( 20 ). Anti-gangliosides antibodies would have been helpful, together with NCS, in differentiating CIP from axonal GBS, but they were not available in our hospital ( 35 , 129 ).…”