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Kinetics of anti-peripheral nerve myelin antibody in patients with Guillain-Barré syndrome treated and not treated with plasmapheresis.

Serial anti-peripheral nerve myelin antibody titers were determined in 28 consecutive patients with Guillain-Barré syndrome during the course of their illness. Eighteen patients were treated with plasmapheresis and 10 were not. Anti-peripheral nerve myelin antibody titers in the group treated with plasmapheresis declined significantly more rapidly than in the group not treated with plasmapheresis. Five patients treated with plasmapheresis who showed initial clinical improvement, with a concurrent decline in anti-peripheral nerve myelin antibody titer, had one or two recurrences of clinical symptoms during a 2- to 8-week period associated with an increase in anti-peripheral nerve myelin antibody titer. Recurrent weakness was severe enough to prompt additional courses of plasmapheresis. The data suggest that serial determinations of antiperipheral nerve myelin antibody in patients with Guillain-Barré syndrome may identify patients with antibody rebound associated with recurrence of clinical symptoms and prolonged recovery in whom further plasmapheresis should be considered.