Plasma exchange for Guillain-Barré syndrome

Raphaël JC, Chevret S, Hughes RAC, Annane D

Published Online:

October 8, 2008

Guillain-Barré syndrome is a rare but serious disease of the peripheral nerves (nerves outside the central nervous system) that causes paralysis. Many patients have had a recent chest or stomach infection that may cause an allergic response in the nerves. Autoimmune factors such as antibodies are thought to cause the disease, so plasma exchange is used to treat Guillain-Barré syndrome. Plasma exchange aims to remove these antibodies from the blood stream and replace them with artificial plasma, usually albumin. This review of six randomised controlled trials involving 649 participants found that plasma exchange helps speed recovery from Guillain-Barré syndrome. It is more beneficial when started within seven days of the disease onset. No new trials have been done since the first publication of this review.

Abstract (click to read)

Background:

Guillain-Barré syndrome is an acute paralysing disease due to peripheral nerve inflammation.

Objectives:

To systematically review the evidence on plasma exchange for treating Guillain-Barré syndrome.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Trials Register (January 2008), MEDLINE (January 1966 to January 21 2008) and EMBASE (January 1980 to January 21 2008) .

Selection criteria:

Randomised and quasi-randomised trials of plasma exchange versus sham exchange or supportive treatment.

Data collection and analysis:

Two authors agreed the selection of eligible studies with a third author. Data were extracted by one author and checked by a second.

Main results:

In the first version of this review there were six eligible trials concerning 649 participants comparing plasma exchange with supportive treatment. No new eligible trials have been identified in subsequent updates.

Primary outcome measures
In one trial with 220 severely affected participants, the median time to recover walking with aid was significantly faster, 30 days, with plasma exchange than without, 44 days. In another trial with 91 mildly affected participants, this time was not significantly different but the median time to onset of motor recovery was significantly shorter, 6 days, with plasma exchange than without, 10 days.

Secondary outcome measures
In five trials with 623 patients in total, the relative risk of being improved by one or more grades after four weeks was 1.64 ( 95% CI 1.37 to 1.96) in favour of plasma exchange. Patients treated with plasma exchange also fared significantly better in time to recover walking without aid, requirement for artificial ventilation, duration of ventilation, and full muscle strength recovery and severe sequelae after one year. There were fewer patients with infectious events and cardiac arrhythmias in the plasma exchange than the control group.

Authors' conclusions:

In mild Guillain-Barré syndrome, two sessions of plasma exchange are significantly superior to none. In moderate Guillain-Barré syndrome four sessions are significantly superior to two. In severe Guillain-Barré syndrome, six sessions of plasma exchange are not significantly better than four. Continuous flow plasma exchange machines may be superior to intermittent flow machines and albumin to fresh frozen plasma as the exchange fluid. Plasma exchange is more beneficial when started within seven days after disease onset rather than later, but was still beneficial in patients treated up to 30 days after disease onset. The value of plasma exchange in children less than 12 years old is not known. There is insufficient evidence to determine whether cerebrospinal fluid filtration is equivalent to plasma exchange.

This record should be cited as:

Raphaël JC, Chevret S, Hughes RAC, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD001798. DOI: 10.1002/14651858.CD001798

Assessed as up to date:

January 21, 2008

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Neuromuscular Disease Group

Health topics:

Neurology > Peripheral neuropathy > Guillain-Barre syndrome

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Plasma exchange for Guillain-Barré syndrome

More like this

Copyright © 2012 - The Cochrane Collaboration