Plasma exchange and prednisone in Guillain-Barré syndrome

A controlled randomized trial

Mendell, J. R.
Kissel, J. T.
Kennedy, M. S.
Sahenk, Z.
Grinvalsky, H. T.
Pittman, G. L.
Kyler, R. S.
Roelofs, R. I.
Whitaker, J. N.
Bertorini, T. E.

From Ohio State University Hospitals, Columbus, OH; University of Minnesota Hospital, Minneapolis, MN; and the VA Hospital, Memphis, TN.

Address correspondence and reprint requests to Dr. Mendell, Ohio State University, 466 West 10th Avenue, Columbus, OH 43210.

Accepted for publication March 7, 1985.

Neurology 35(11):p 1551-1555, November 1985.

Article abstract

A controlled randomized trial of plasma exchange combined with prednisone was compared with supportive care alone in patients with Guillain-Barré syndrome (GBS). There was no significant improvement in the treated group over the controls. The sample size, albeit small (12 treated and 13 controls), had the power (95% chance) to detect a change of 2 British Medical Research Council grades of strength between the groups. The difference in our results and others that indicated a beneficial effect of plasma exchange may reflect an adverse effect of prednisone on recovery in GBS. Failure to find a benefit of plasma exchange in our patients also raises the possibility that GBS may be a heterogeneous disorder with humoral factors playing a role in some but not all patients.