CSF filtration is an effective treatment of Guillain–Barré syndrome

Wollinsky, K. H.; Hülser, P.-J.; Brinkmeier, Heinrich; Aulkemeyer, Peter; Bössenecker, Wolfgang; Huber-Hartmann, Karl-Heinz; P, Rohrbach; Schreiber, Herbert; Weber, Frank; Kron, Martina; Büchele, Gisela; Mehrkens, H.-H.; Ludolph, Albert C.; Rüdel, Reinhardt

doi:10.1212/wnl.57.5.774

Cited by 90 publications

(36 citation statements)

References 36 publications

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“…24,25 There was no difference in outcomes between the groups; however, the numbers were too small to demonstrate equivalence convincingly, and the procedure risks intrathecal infection.…”

Section: Plasma Exchangementioning

confidence: 92%

Practice parameter: Immunotherapy for Guillain–Barré syndrome

et al. 2003

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Abstract-Objective:To provide an evidence-based statement to guide physicians in the management of Guillain-Barré syndrome (GBS). Methods: Literature search and derivation of evidence-based statements concerning the use of immunotherapy were performed. Results: Treatment with plasma exchange (PE) or IV immunoglobulin (IVIg) hastens recovery from GBS. Combining the two treatments is not beneficial. Steroid treatment given alone is not beneficial. Recommendations: 1) PE is recommended for nonambulant adult patients with GBS who seek treatment within 4 weeks of the onset of neuropathic symptoms. PE should also be considered for ambulant patients examined within 2 weeks of the onset of neuropathic symptoms; 2) IVIg is recommended for nonambulant adult patients with GBS within 2 or possibly 4 weeks of the onset of neuropathic symptoms. The effects of PE and IVIg are equivalent; 3) Corticosteroids are not recommended for the management of GBS; 4) Sequential treatment with PE followed by IVIg, or immunoabsorption followed by IVIg is not recommended for patients with GBS; and 5) PE and IVIg are treatment options for children with severe GBS. NEUROLOGY 2003;61:736 -740 Guillain-Barré syndrome (GBS) affects between 1 and 4 per 100,000 of the population annually throughout the world, 1 causing respiratory failure requiring ventilation in approximately 25%, death in 4 to 15%, 2-6 persistent disability in approximately 20%, 7 and persistent fatigue in 67%. 8 The costs in the United States have been estimated as $110,000 for direct health care and $360,000 in lost productivity per patient. 9 This practice parameter classifies the relevant evidence on immunotherapy to provide evidence-based recommendations for the management of GBS. 10Evidence review. A search of MEDLINE from 1966 and of the Cochrane library was performed in March 2002. "Polyradiculoneuritis" was limited by "human" and cross-referenced with "therapy." The search results were reviewed for each question by at least two members of the practice parameter group and supplemented from the reference lists in the articles retrieved and the personal reference lists of the members of the practice parameter group. Those titles representing relevant randomized controlled trials (RCTs) are included in the tables on the Neurology Web site for this article (www.neurology.org). Recommendations were graded according to the levels established by the AAN Quality Standards Subcommittee at the inception of this project (table).

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“…24,25 There was no difference in outcomes between the groups; however, the numbers were too small to demonstrate equivalence convincingly, and the procedure risks intrathecal infection.…”

Section: Plasma Exchangementioning

confidence: 92%

Practice parameter: Immunotherapy for Guillain–Barré syndrome

et al. 2003

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“…CSF filtration was reported to be at least as effective as PE in a randomized controlled trial on 37 patients [119], but the number of patients was too small to draw a definite conclusion. Similarly, the anecdotal response to Interferon-β la [30] and of a second course of IVIg in severely affected patients, unresponsive to the first administration of IVIg [28], awaits confirmation by appropriately designed controlled trials.…”

Section: Guillain-barré Syndromementioning

confidence: 93%

Treatment of dysimmune neuropathies

Nobile‐Orazio

2005

J Neurol

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Several therapies are currently used in dys-immune neuropathies including steroids,plasma exchange (PE), high-dose intravenous immunoglobulins(IVIg), and immuno-suppressive agents (IS). Even if there is substantial evidence that these treatments may improve the course of the neuropathy, their effectiveness is far from being complete and is sometime hampered by the occurrence of associated side effects. In Guillain-Barré syndrome (GBS),IVIg and PE are similarly effective in accelerating the recovery but there is still little evidence that they can reduce mortality or long-term disability. Recent reports on the association of intravenous methylprednisolone or interferon-beta (IFN-beta) to IVIg did not result in significant further improvement. In chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) steroids, PE, and IVIG are initially similarly effective. The short-term effect of PE and IVIgand the side effects associated with the long-term use of steroids have prompted the use of several IS, interferon and,more recently, the anti-CD20 monoclonal-antibody Rituximab, but their efficacy has still to be proved in controlled studies. The recent identification of multifocal motor neuropathy(MMN) was shortly followed by the finding of an effective therapy. Almost 80% of patients respond toIVIg whose effect needs to be maintained with periodic infusions for long periods of time, and tends to decrease after several years. Also in this condition a number of immune modulating agents have been used to reduce the frequency or improve the effectiveness of IVIg,but their efficacy has not been sofar confirmed in randomized trials. Similar conclusions can be drawn for neuropathies associated with monoclonal gammopathies where only PE and IVIg have proved to be effective in controlled studies,while the promising initial results obtained with Rituximab in neuropathy associated IgM monoclonal gammopathy awaits confirmation from controlled trials.

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“…258 Filtration of CSF has been investigated in a small prospective study of 37 GBS patients. 277 The repeated removal of small volumes of CSF through a lumbar catheter, followed by filtration through a millipore filter and reinfusion through the same catheter, was well tolerated and found to be equally safe and effective compared to conventional plasmapheresis. The rationale of this therapeutic approach rests in the notion that the nerve roots are promi-nently affected in some GBS cases and, therefore, that filtration of CSF rather than whole plasma might be more efficient.…”

Section: Guillain-barré Syndromementioning

confidence: 98%

Advances in understanding and treatment of immune‐mediated disorders of the peripheral nervous system

et al. 2004

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During recent years, novel insights in basic immunology and advances in biotechnology have contributed to an increased understanding of the pathogenetic mechanisms of immune-mediated disorders of the peripheral nervous system. This increased knowledge has an impact on the management of patients with this class of disorders. Current advances are outlined and their implication for therapeutic approaches addressed. As a prototypic immune-mediated neuropathy, special emphasis is placed on the pathogenesis and treatment of the Guillain-Barré syndrome and its variants. Moreover, neuropathies of the chronic inflammatory demyelinating, multifocal motor, and nonsystemic vasculitic types are discussed. This review summarizes recent progress with currently available therapies and--on the basis of present immunopathogenetic concepts--outlines future treatment strategies.

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CSF filtration is an effective treatment of Guillain–Barré syndrome

Abstract: Although the number of patients was small, the authors found that the treatment of GBS with CSFF is at least as effective as with PE. CSFF might work by removing from the CSF inflammatory mediators, autoantibodies, or other factors.

Cited by 90 publications

References 36 publications

Practice parameter: Immunotherapy for Guillain–Barré syndrome

Practice parameter: Immunotherapy for Guillain–Barré syndrome

Treatment of dysimmune neuropathies

Advances in understanding and treatment of immune‐mediated disorders of the peripheral nervous system

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