Over the course of a few days in late September of 2021, Carol Cerase of Lumberton, NC, experienced increasing weakness in her legs, trouble swallowing, and several falls. Doctors at her local hospital couldn’t find the cause, so they reached out to Duke Health’s neurology experts, who diagnosed Cerase with Guillain-Barré syndrome (GBS). Duke’s team recommended plasma exchange therapy to stop the disease’s progression and allow the nerves to heal. “I was lucky I got the treatment so fast,” said Cerase. “I think it saved me.”
Mysterious Symptoms Cause Concern
Cerase, 71, noticed her legs felt extra tired one evening after doing yard work but brushed it off. Within days her symptoms worsened. Weakness, numbness, and tingling -- classic signs of a nerve disorder -- caused her to fall several times. The last time, she couldn’t get back up.
“That’s when we called the ambulance,” Cerase said. “I was terrified, because I had no clue what was going on.”
Her local hospital couldn’t find the cause for her decline, but a consultation with Duke’s neurology team led to a diagnosis of Guillain-Barré syndrome. The rare autoimmune disorder is a neuropathy, or nerve disorder, that affects one in 100,000 people. Antibodies attack the nerves, which control important body functions like breathing and moving.
Plasma Exchange Therapy Stops Guillain-Barre’s Progression
When standard treatment didn’t work quickly enough, Cerase was transferred to Duke. Soon she wasn't able to swallow or breathe on her own. Duke neurology nurse practitioner Elizabeth Devore could tell Cerase was scared.
“I wanted Carol to know that while she felt like she wasn't in control of what was happening to her body, we knew how to treat her, and we were going to do everything we could to take care of her,” Devore said.
Devore and Duke neurologist Jordan Mayberry, MD, quickly started Cerase on plasma exchange therapy, also called plasmapheresis or PLEX therapy.
“I liken it to a washing machine,” Dr. Mayberry said. Put simply, “It sucks out the bad stuff, separates it, and then returns the good stuff, plus some extra fluids.” In other words, plasma exchange therapy removes destructive antibodies so they can no longer attack the nerves. This allows the nerves to regenerate.
Cerase received the therapy through a port in her neck over several hours each session. She had five sessions in about 10 days. She slowly began to improve and regain the ability to sit up, swallow, and breathe independently.
An Uphill Battle Back to Health
In October, Cerase was well enough to transfer to an inpatient rehabilitation facility in Fayetteville. She still couldn’t walk on her own but made quick progress. After three weeks of rehab, she returned home.
In early November, Cerase walked unassisted into her follow-up appointment at Duke.
“I almost didn't recognize her because she was actually walking down the hall on her own to get into the patient room,” Mayberry said. “That told me everything I needed to know.”
Cerase still has some lingering effects of Guillain-Barré, but she’s getting stronger every day. She went to lunch with friends recently and looks forward to driving again. Her life, she said, is almost back to normal.
Experiencing Similar Symptoms? Seek Emergency Care
Dr. Mayberry encourages you to seek care immediately if you experience numbness, pain, tingling, and weakness -- signs of neuropathy -- that come on quickly.
“Neuropathy symptoms that progress in days or weeks are a big red flag. You need to be evaluated quickly so you, like Carol, can get treatment to stop the progression,” he said.