Acute Guillain-Barre syndrome (GBS) is a demyelinating polyneuropathy which 
responds readily to plasma exchange (PEX). According to the North American Acute 
GBS PEX study there is a 50% or more reduction in the recovery time if PEX is 
initiated early in the course of the disease. Demyelinating antibodies are 
usually IgM. IgA antibodies require prolonged PEX. Patients with predominant IgG 
antibodies have chronic inflammatory demyelinating polyneuropathy (CIDP), which 
requires an even longer course of PEX, over weeks to months or years. We 
reviewed records of 73 patients with the initial diagnosis of GBS treated with 
PEX. Among these patients, 55 had classic GBS, three had the Miller-Fisher 
variant, two had CIDP, and 13 had demyelinating-like polyneuropathies associated 
with other conditions including malignancy, vaccine-related myelitis, 
steroid-induced myopathy, polymyositis, botulism, gram-negative sepsis, 
Sjogren's, and AIDS. Hughes grading system was used. Patients were graded 3 to 
5, with grade 3 patients being unable to walk 5 m without support, grade 4 
patients being bed or chair bound, and grade 5 patients being ventilator 
dependent. Of 60 unassociated (GBS) demyelinating cases receiving a mean of 6.5 
PEX procedures, 13 (21%) were intubated early in the treatment, with four (6%) 
remaining ventilator dependent post-PEX. Of 51 non-intubated patients, 15 became 
ambulatory post-PEX. Patients with the Miller-Fisher variant showed improvement 
within 6 hours of PEX initiation. We did not investigate correlation of GBS with 
infection; however, we did observe a rise in CMV titer among 15% of the 58 
patients with acute GBS. Considering our results we believe that intensive PEX 
on a daily basis for a few days is necessary for severely affected individuals. 
We advise five to nine procedures at consultation unless early, rapid recovery 
occurs.