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July 1993

What Treatment for the Guillain-Barré Syndrome?-Reply

Author Affiliations

Neurology Service St Elizabeth's Hospital 736 Cambridge St Boston, MA 02135

Arch Neurol. 1993;50(7):687-688. doi:10.1001/archneur.1993.00540070007005

In Reply.  —McFarland makes a good point that therapy for the Guillain-Barré syndrome should be individualized, but I am unsure what clinical or electrophysiologic features indicate the best treatment. There are three related issues: whom to treat, when, and what therapy. Three trials have shown that the benefits of plasma exchange outweigh the risks if a patient is unable to walk independently, namely, "overall management morbidity," to borrow a term from the similar literature on subarachnoid hemorrhage, is better with treatment. Because of disappointing results with gamma globulin at my institution over the past year (half of the patients becoming worse by one clinical grade during or soon after the infusion, as well as several severe relapses), I have, for the moment, used plasma exchange in most patients who are progressing during the first 2 weeks. A question commonly arises in patients who have very mild weakness, or those variants,

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