Approximately 20 per cent of patients require mechanical ventilation while 15 per cent remain with residual deficits. It appears to be mediated by an antimyelin antibody. The efficacy of plasmapheresis is well supported by two multicenter randomized trials which demonstrated significant clinical improvement in terms of reduced mortality, shorter functional recovery time, and decreased requirement for mechanical ventilation. Patients receiving plasmapheresis early in the course of their disease benefited more, particularly if they required mechanical ventilation at the time of initiation of therapy, but also if they required mechanical ventilation subsequent to the initiation of plasmapheresis. In a randomized trial comparing plasmapheresis and intravenous immunoglobulin, the two modes of treatment were comparable, with a slight advantage to immunoglobulin. However, the plasmapheresis schedule used in the study was less aggressive than that usually recommended for Guillain-Barré syndrome.
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