Sept. 22, 2003 -- The American Academy of Neurology (AAN) presents new guidelines for the treatment of Guillain-Barré syndrome (GBS) in the Sept. 23 issue of Neurology. These guidelines emphasize early treatment with either intravenous immunoglobulin (IVIg) or plasma exchange, but they note that these two treatments should not be combined.
"People who are severely affected should be treated early with either IVIg or plasma exchange," lead author Richard Hughes, MD, from Guy's, King's and St. Thomas' School of Medicine in London, England, says in a news release. "Neurologists and their patients should consider that IVIg has somewhat fewer side effects and is more convenient."
A review of published evidence suggests that treating GBS within two to four weeks after symptom onset may decrease recovery time. Plasma exchange and IVIg are equally effective if given early to adults with severe GBS, and they could also be considered in children with severe GBS.
However, there is no additional benefit from combining IVIg and plasma exchange, or from administering them sequentially. Corticosteroids were not shown to be effective and were therefore not recommended. Although data on combination therapies, using steroids combined with IVIg or two courses of IVIg or plasma exchange, are not currently available, this approach may be promising.
"The bottom line here is that IVIg, or immunoglobulin infusion, is the preferred treatment for Guillain-Barré, depending on availability," says second author Eelco Wijdicks, MD, from the Mayo Clinic in Rochester, Minnesota, while noting that shortages of gamma globulin may compromise this approach.
"There is no question that plasma exchange could have more complications. Hypotension...is possible. Catheter placement in large veins has a tendency to cause more complications," he says, adding that plasma exchange also requires a specialized, experienced treatment team. "IVIg is easier to use and there are fewer complications. With evidence of comparable effect, it should be the treatment of choice."
Neurology. 2003;61:736-740
Reviewed by Gary D. Vogin, MD
No comments:
Post a Comment