Modified Zipper Method: A Promising Treatment Option in Severe Pediatric Cases of Immune-Mediated Neurological Disorders

Background/Purpose: Guillain–Barré syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are immune-mediated neurological disorders characterized by rapid-onset and progressive clinical course. Despite generally favorable outcome in children, severe cases are reported regularly. Immunotherapy regimes including intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) exist, but outcome of severe cases remains unsatisfactory and mortality high. In 2018, a novel treatment strategy with alternating IVIG and PLEX (“zipper method”) was reported in nine pediatric GBS patients with promising results. Here, we present a modified “zipper method” for treatment of various neuroimmunological diseases.