A Novel Treatment Strategy for Severe Guillain-Barré Syndrome: Zipper Method:

Objective:Intravenous immunoglobulin and plasma exchange are proven treatments for Guillain-Barre syndrome. Despite these treatments, the prognosis for severe Guillain-Barre syndrome is still not satisfactory. This article seeks for a logical timing for plasma exchange–intravenous immunoglobulin synergy, which may improve outcome in severe Guillain-Barre syndrome requiring mechanical ventilation.Study Design:This study is an open-label study. Nine pediatric severe Guillain-Barre syndrome patients requiring mechanical ventilation were treated with novel treatment strategy named as “zipper method.” In this method, following diagnosis of Guillain-Barre syndrome, plasma exchange was started immediately. In the first session of plasma exchange, one and a half volume of patients’ plasma was removed by using 5% albumin as replacement solution. At the end of the plasma exchange session, 0.4 g/kg intravenous immunoglobulin infusion was started immediately. Second plasma exchange session was applied with one volume...