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

Stoian,Adina; Șerban,Georgiana; Bajko,Zoltan; Andone,Sebastian; Mosora,Oana; Bălașa,Adrian

doi:10.3892/etm.2021.9696

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

Authors:
- Adina Stoian
- Georgiana Șerban
- Zoltan Bajko
- Sebastian Andone
- Oana Mosora
- Adrian Bălașa
View Affiliations

Affiliations: Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania, Neurosurgery Clinic, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
Published online on: January 25, 2021 https://doi.org/10.3892/etm.2021.9696
Article Number: 265
Copyright: © Stoian et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	Afifi AK: The landry-guillain-barré strohl syndrome 1859 to 1992 a historical perspective. J Family Community Med. 1:30–34. 1994.PubMed/NCBI
2	Dash S, Pai AR, Kamath U and Rao P: Pathophysiology and diagnosis of guillain-barré syndrome-challenges and needs. Int J Neurosci. 125:235–240. 2015.PubMed/NCBI View Article : Google Scholar
3	Hiraga A, Mori M, Ogawara K, Hattori T and Kuwabara S: Differences in patterns of progression in demyelinating and axonal guillain-barre syndromes. Neurology. 61:471–474. 2003.PubMed/NCBI View Article : Google Scholar
4	Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, et al: Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the american society for apheresis: The eighth special issue. J Clin Apher. 34:171–354. 2019.PubMed/NCBI View Article : Google Scholar
5	Stoian A, Motataianu A, Bajko Z and Balasa A: Guillain-Barré and acute transverse myelitis overlap syndrome following obstetric surgery. J Crit Care Med (Targu Mures). 6:74–79. 2020.PubMed/NCBI View Article : Google Scholar
6	Omejec G and Podnar S: Retrospective analysis of slovenian patients with guillain-barré syndrome. J Peripher Nerv Syst. 17:217–219. 2012.PubMed/NCBI View Article : Google Scholar
7	Kuwabara S: Axonal guillain-barré syndrome is underestimated in Europe? J Neurol Neurosurg Psychiatry. 81(1063)2010.PubMed/NCBI View Article : Google Scholar
8	Kuwabara S and Yuki N: Axonal guillain-barré syndrome: Concepts and controversies. Lancet Neurol. 12:1180–1188. 2013.PubMed/NCBI View Article : Google Scholar
9	Yuki N, Taki T, Inagaki F, Kasama T, Takahashi M, Saito K, Handa S and Miyatake T: A bacterium lipopolysaccharide that elicits Guillain-Barré syndrome has a GM1 ganglioside-like structure. J Exp Med. 178:1771–1775. 1993.PubMed/NCBI View Article : Google Scholar
10	Ho TW, Willison HJ, Nachamkin I, Li CY, Veitch J, Ung H, Wang GR, Liu RC, Cornblath DR, Asbury AK, et al: Anti-GD1a antibody is associated with axonal but not demyelinating forms of guillain-barré syndrome. Ann Neurol. 45:168–173. 1999.PubMed/NCBI View Article : Google Scholar
11	Ang CW, Jacobs BC and Laman JD: The guillain-barré syndrome: A true case of molecular mimicry. Trends Immunol. 25:61–66. 2004.PubMed/NCBI View Article : Google Scholar
12	Kuwabara S, Bostock H, Ogawara K, Sung JY, Kanai K, Mori M, Hattori T and Burke D: The refractory period of transmission is impaired in axonal guillain-barré sindromes. Muscle Nerve. 28:683–689. 2003.PubMed/NCBI View Article : Google Scholar
13	Hafer-Macko C, Hsieh ST, Li CY, Ho TW, Sheikh K, Cornblath DR, McKhann GM, Asbury AK and Griffin JW: Acute motor axonal neuropathy: An antibody-mediated attack on axolemma. Ann Neurol. 40:635–644. 1996.PubMed/NCBI View Article : Google Scholar
14	Kalita J, Misra UK and Das M: Neurophysiological criteria in the diagnosis of different clinical types of guillain-barre syndrome. J Neurol Neurosurg Psychiatry. 79:289–293. 2008.PubMed/NCBI View Article : Google Scholar
15	van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC and van Doorn PA: Guillain-Barré syndrome: Pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 10:469–482. 2014.PubMed/NCBI View Article : Google Scholar
16	Hughes RA and Cornblath DR: Guillain-Barré syndrome. Lancet. 366:1653–1666. 2005.PubMed/NCBI View Article : Google Scholar
17	Kuwabara S, Asahina M, Koga M, Mori M, Yuki N and Hattori T: Two patterns of clinical recovery in guillain-barré syndrome with IgG anti-GM1 antibody. Neurology. 51:1656–1660. 1998.PubMed/NCBI View Article : Google Scholar
18	Stoian A, Moțățăianu A, Bărcuțean L, Maier S, Bazko Z, Voidăzan S, Fărcaș A and Bălașa R: Understandig the mechanism of action of intravenous immunoglobulins: A ten years experience in treating guillain-barré syndrome. Farmacia. 68:426–435. 2020.
19	Kleyweg RP, van der Meché FG and Schmitz PI: Interobserver agreement in the assessment of muscle strength and functional abilities in guillain-barré syndrome. Muscle Nerve. 14:1103–1109. 1991.PubMed/NCBI View Article : Google Scholar
20	Hughes RA, Newsom-Davis JM, Perkin GD and Pierce JM: Controlled trial prednisolone in acute polyneuropathy. Lancet. 2:750–753. 1978.PubMed/NCBI View Article : Google Scholar
21	Zhang G, Li Q, Zhang R, Wei X, Wang J and Qin X: Subtypes and prognosis of guillain-barré syndrome in Southwest China. PLoS One. 10(e0133520)2015.PubMed/NCBI View Article : Google Scholar
22	Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, Asbury AK, Blaser MJ and McKhann GM: Guillain-Barre syndrome in northern China Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 118:597–605. 1995.PubMed/NCBI View Article : Google Scholar
23	Ye Y, Wang K, Deng F and Xing Y: Electrophysiological subtypes and prognosis of guillain-barré syndrome in northeastern China. Muscle Nerve. 47:68–71. 2013.PubMed/NCBI View Article : Google Scholar
24	Estrade S, Guiomard C, Fabry V, Baudou E, Cances C, Chaix Y, Cintas P, Meyer P and Cheuret E: Prognostic factors for the sequelae and severity of guillain-barré syndrome in children. Muscle Nerve. 60:716–723. 2019.PubMed/NCBI View Article : Google Scholar
25	Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV and Swan AV: The plasma exchange/sandoglobulin guillain-barré syndrome trial group. electrophysiological classification of guillain-barré syndrome: Clinical associations and outcome. Ann Neurol. 44:780–788. 1998.PubMed/NCBI View Article : Google Scholar
26	Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H and Watkins RP: A prospective study of acute idiopathic neuropathy. II. Antecedent events. J Neurol Neurosurg Psychiatry. 51:613–618. 1998.PubMed/NCBI View Article : Google Scholar
27	Hemachudha T, Griffin DE, Chen WW and Johnson RT: Immunologic studies of rabies vaccination-induced GBS. Neurology. 38:375–378. 1998.PubMed/NCBI View Article : Google Scholar
28	Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D, Clark S, Haber P, Stolley PD, Schonberger LB and Chen RT: The guillain-barre´ syndrome and the 1992-1993 and 1993-1994 influenza vaccines. N Engl J Med. 339:1797–1802. 1998.PubMed/NCBI View Article : Google Scholar
29	Kozanoglu I, Yerdelen D, Buyukkurt N, Yeral M, Boga C and Ozdogu H: A retrospective study on patients with guillain-barré syndrome treated with therapeutic plasma exchange and other treatment options-a centre's experience. Eur Neurological Rev. 10:81–84. 2015.
30	Huy PP and Schwartz J: Therapeutic plasma exchange in guillain-barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med. 48:338–346. 2019.PubMed/NCBI View Article : Google Scholar
31	Chevret S, Hughes RA and Annane D: Plasma exchange for guillain-barré syndrome. Cochrane Database Syst Rev. 2(CD00179)2017.PubMed/NCBI View Article : Google Scholar
32	McKhann GM, Griffin JW, Cornblath DR, Mellits ED, Fisher RS and Quaskey SA: Plasmapheresis and guillain-barré syndrome: Analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol. 23:347–353. 1998.PubMed/NCBI View Article : Google Scholar
33	Derksen RH, Schuurman HJ, Meyling FH, Struyvenberg A and Kater L: The efficacy of plasma exchange in the removal of plasma components. J Lab Clin Med. 104:346–354. 1984.PubMed/NCBI
34	Appropriate number of plasma exchanges in Guillain-Barré syndrome. The French Cooperative Group on plasma exchange in Guillain-Barré syndrome. Appropriate number of plasma exchanges in Guillain-Barré syndrome. Ann Neurol. 41:298–306. 1997.PubMed/NCBI View Article : Google Scholar
35	Espérou H, Jars-Guincestre MC, Bolgert F, Raphaël JC and Durand-Zaleski I: French cooperative group on plasma exchange in guillain-barré syndrome. Cost-effectiveness of plasma exchange therapy for the treatment of guillain-barré syndrome. Intensive Care Med. 26:1094–1100. 2000.PubMed/NCBI View Article : Google Scholar
36	Shemin D, Briggs D and Greenan M: Complications of therapeutic plasma exchange: A prospective study of 1,727 procedures. J Clin Apher. 22:270–276. 2007.PubMed/NCBI View Article : Google Scholar
37	Dhanya NB, Rai R and Srinivas CR: Histamine 2 blocker potentiates the effects of histamine 1 blocker in suppressing histamine-induced wheal. Indian J Dermatol Venereol Leprol. 74:475–477. 2008.PubMed/NCBI View Article : Google Scholar
38	Ogawara K, Kuwabara S, Mori M, Hattori T, Koga M and Yuki N: Axonal guillain-barré syndrome: Relation to anti-ganglioside antibodies and Campylobacter jejuni infection in Japan. Ann Neurol. 48:624–631. 2000.PubMed/NCBI
39	Paradiso G, Tripoli J, Galicchio S and Fejerman N: Epidemiological, clinical, and electrodiagnostic findings in childhood guillain-barré syndrome: A reappraisal. Ann Neurol. 46:701–717. 1999.PubMed/NCBI View Article : Google Scholar
40	Chareyre J, Hully M, Simonnet H, Musset L, Barnerias C, Kossorotoff M, Quijano-Roy S, Desguerre I and Gitiaux C: Acute axonal neuropathy subtype of guillain barré syndrome in a French pediatric series: Adequate follow-up may require repetitive electrophysiological studies. Eur J Paediatr Neurol. 21:891–897. 2017.PubMed/NCBI View Article : Google Scholar
41	Tekgul H, Serdaroglu G and Tutuncuoglu S: Outcome of axonal and demyelinating forms of guillain-barré syndrome in children. Pediatr Neurol. 28:295–299. 2003.PubMed/NCBI View Article : Google Scholar
42	Zhang Y, Zhao Y and Wang Y: Prognostic factors of guillain-barré syndrome: A 111-case retrospective review. Chin Neurosurg J. 14:1–9. 2018.PubMed/NCBI View Article : Google Scholar
43	Akbayram S, Doğan M, Akgün C, Peker E, Sayιn R, Aktar F, Bektaş MS and Caksen H: Clinical features and prognosis with guillain-barré syndrome. Ann Indian Acad Neurol. 14:98–102. 2011.PubMed/NCBI View Article : Google Scholar
44	Gonzalez-Suarez I, Sanz-Gallego I, Rodriguez de Rivera FJ and Arpa J: Guillain-Barre syndrome: Natural history and prognostic factors: A retrospective review of 106 cases. BMC Neurol. 13(95)2013.PubMed/NCBI View Article : Google Scholar
45	Bradshaw DY and Jones HR Jr: Guillain-Barré syndrome in children: Clinical course, electrodiagnosis, and prognosis. Muscle Nerve. 15:500–506. 1992.PubMed/NCBI View Article : Google Scholar
46	Raphaël JC, Chevret S, Hughes RA and Annane D: Plasma exchange for guillain-barré syndrome. Cochrane Database Syst Rev. 7(CD001798)2012.PubMed/NCBI View Article : Google Scholar
47	Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW and Jacobs BC: Early recognition of poor prognosis in guillain-barre syndrome. Neurology. 76:968–975. 2011.PubMed/NCBI View Article : Google Scholar
48	Lee JH, Sung IY and Rew IS: Clinical presentation and prognosis of childhood guillain-barré syndrome. J Paediatr Child Health. 44:449–454. 2008.PubMed/NCBI View Article : Google Scholar
49	Sakakibara R, Hattori T, Kuwabara S, Yamanishi T and Yasuda K: Micturitional disturbance in patients with guillain-barre syndrome. J Neurol Neurosurg Psychiatr. 63:649–653. 1997.PubMed/NCBI View Article : Google Scholar
50	Sharshar T, Chevret S, Bourdain F and Raphaël JC: French cooperative group on plasma exchange in guillain-barré syndrome. Early predictors of mechanical ventilation in guillain-barré syndrome. Crit Care Med. 31:278–283. 2003.PubMed/NCBI View Article : Google Scholar
51	Van Doorn PA, Ruts L and Jacobs BC: Clinical features, pathogenesis, and treatment of guillain-barré syndrome. Lancet Neurol. 7:939–950. 2008.PubMed/NCBI View Article : Google Scholar
52	Van Doorn PA, Kuitwaard K, Walgaard C, van Koningsveld R, Ruts L and Jacobs BC: IVIG treatment and prognosis in guillain-barré syndrome. J Clin Immunol. 30 (Suppl):S74–S78. 2010.PubMed/NCBI View Article : Google Scholar
53	Buzzigoli SB, Genovesi M, Lambelet P, Logi C, Raffaelli S and Cattano D: Plasmapheresis treatment in guillain-barré syndrome: Potential benefit over intravenous immunoglobulin. Anaesth Intensive Care. 38:387–389. 2010.PubMed/NCBI View Article : Google Scholar
54	Dada MA and Kaplan AA: Plasmapheresis treatment in guillain-barré syndrome: Potential benefit over IVIg in patients with axonal involvement. Ther Apher Dial. 8:409–412. 2004.PubMed/NCBI View Article : Google Scholar
55	Chaudhuri JR, Alladi S, Mridula KR, Boddu DB, Rao MV, Hemanth C, Dhanalaxmi V, Reddy JM, Rao SM, Balaraju B, et al: Clinical outcome of Guillain-Barré syndrome with various treatment methods and cost effectiveness: A study from tertiary care center in South India: Yashoda GBS Registry. Neurol Asia. 19:263–270. 2014.
56	Nagpal S, Benstead T, Shumak K, Rock G, Brown M and Anderson DR: Treatment of guillain-barré syndrome: A cost-effectiveness analysis. J Clin Apher. 14:107–113. 1999.PubMed/NCBI View Article : Google Scholar
57	Winters JL, Brown D, Hazard E, Chainani A and Andrzejewski C Jr: Cost-Minimization analysis of the direct costs of TPE and IVIg in the treatment of guillain-barré syndrome. BMC Health Serv Res. 11(101)2011.PubMed/NCBI View Article : Google Scholar
58	Balasa R: Therapeutic plasma exchange: An indispensable therapy for severe neurological condition. J Crit Care Med (Targu Mures). 6:89–90. 2020.PubMed/NCBI View Article : Google Scholar
59	Al Hamdani S, Aljanabi FY, Abdulrasool MI and Salman AH: Child with guillain-barré syndrome responding to plasmapheresis: A case report. Case Rep Acute Med. 3:4–11. 2020.PubMed/NCBI View Article : Google Scholar