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From the Department of Anesthesiology/Intensive Care, Rehabilitation Hospital Ulm (Drs. Wollinsky and Mehrkens); the Neurological Clinic Wangen (Dr. Hülser); the Department of Neurology, District Hospital Heidenheim (Drs. Bössenecker, Huber–Hartmann, and Rohrbach); the Department of Neurology, Military Hospital Ulm (Dr. Weber); and the Department of Biometry and Medical Documentation (Dr. Kron and G. Büchele), General Physiology (Drs. Brinkmeier, Aulkemeyer, and Rüdel), and Neurology (Drs. Schreiber and Ludolph), University of Ulm, Germany.
Address correspondence and reprint requests to Dr. R. Rüdel, Department of General Physiology, University of Ulm, D-89069 Ulm, Germany; e-mail: reinhardt.rudel{at}medizin.uni-ulm.de
Objective: — To compare CSF filtration (CSFF) and plasma exchange (PE) in the treatment of patients with Guillain–Barré syndrome (GBS).
Methods: — In a prospective controlled clinical trial, 37 patients with acute GBS were randomized to receive either CSFF or PE. Inclusion criteria were fulfillment of National Institute of Neurological and Communicative Disorders and Stroke criteria and disability to walk >5 m unassisted.
Results: — With similar baseline features in both groups (initial disability grades on the six-point grading scale of the GBS Study Group) the primary outcome variable (improvement within 28 days after randomization) was almost identical (test for equivalence p = 0.0014), the mean grade values being 0.82 in the CSFF group and 0.80 in the PE group. After 56 days, 56% (9 of 16 patients) of the CSFF group and 37% (7 of 19 patients) of the PE group had reached grade 2 (i.e., ability of unassisted walking >5 m). After 6 months, the probability to reach grade 2 was about 80% in both groups. In the CSFF group, transient pleocytosis occurred without apparent clinical complications. Clinically relevant complications were higher in the PE-treated group.
Conclusions: — 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.
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