• Nami Inoue, Makoto Kunishige, Sumiko Yoshida, Yasushi Oshima, Yoshiaki Ohnishi, Yasuhiro Kuroda, Atsuko Asano, Hiide Yoshino, Toshio Matsumoto, and Takao Mitsui.
• First Department of Internal Medicine, University of Tokushima School of Medicine, 3 Kuramoto-cho, Tokushima, Tokushima 770-8503, Japan.
• J. Neurol. Sci. 2003 Jun 15; 210 (1-2): 105-8.

AbstractSince plasma exchange (PE) and intravenous immunoglobulin (i.v.Ig) have been widely used in treatment for Guillain-Barré syndrome (GBS), early relapse and treatment-related fluctuation have been a potential problem, but little is known about the mechanism of relapse and fluctuation. We describe a patient who had GBS with treatment-related fluctuation. A 37-year-old Japanese man exhibited acute distal-dominant weakness in upper limbs after upper respiratory infection. His cranial nerve system was normal and muscle weakness was limited to upper limbs. Anti-GT1a IgG was strongly positive and anti-GQ1b IgG was also detected in his serum. Muscle weakness responded well to double-filtration plasmapheresis (DFPP) followed by i.v.Ig, but relapsed 45 days after the initial treatment. Although repeated treatments were effective, the patient showed additional minor deterioration twice. Motor nerve conduction velocities (MCVs) corresponded to the muscle weakness, but elevated level of cerebrospinal fluid (CSF) protein remained and anti-ganglioside antibody titers steadily decreased throughout the clinical course. These findings indicate that the clinical fluctuation was not due to changes in the production of anti-ganglioside antibodies but presumably to the transient beneficial effects of DFPP/i.v.Ig and the outlasting inflammatory response in peripheral nerves.

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