The role of plasmapheresis in childhood Guillain-Barre syndrome was examined by retrospective analysis of children admitted to the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA. Of 23 patients included in the study nine had been treated with plasmapheresis and 14 served as control subjects. Therapeutic plasma exchanges were performed on an alternate day schedule. The mean age was 8.8 years and the duration of the illness prior to admission was 5.9 days. The plasmapheresis treated group recovered to the stage of independent ambulation significantly faster than the control group, 24 versus 60 days, respectively. By six months after discharge all children in both groups were ambulating independently. Plasmapheresis diminished morbidity by shortening the interval until recovery of independent ambulation, but this treatment cannot be routinely advocated for all patients until well designed prospective studies comparing plasmapheresis and IV gamma globulin have been performed in children. 
COMMENT: The proceedings of a symposium on “Autoimmune Neuropathies: Guillain-Barre Syndrome” sponsored by the National Institutes of Health are published in the Annals of Neurology Supplement to Volume 27 1990. Plasmapheresis was the accepted therapy for Guillain-Barre syndrome, particularly in adults, but other approaches are being explored. One is the infusion of immunoglobulins and another is the use of high dose steroids early in the disease. Controlled studies are in progress, but results are not yet available.