[Treatment of Guillain-Barré syndrome]

Abstract

The purpose of this article is to review the most up-to-date information on the treatment of Guillain-Barré syndrome-acute polyradiculoneuritis. Several different treatments for GBS are currently under investigation-plasmapheresis (plasma exchange), high-dosed intravenous gammaglobulin and intravenous corticosteroids. Controlled trials have shown that treatment with plasmapheresis reduced the time spent on a ventilator, in the intensive care unit, and the time needed to regain independent walking. It is generally accepted that plasmapheresis is indicated in severe GBS and for patients who are still in the first two weeks of the disease. High-dosed intravenous immunoglobulins showed their efficacy, at a dosage of 0.4 g/kg/daily for five days. The treatment is easier and morbidity is lower, but both therapies are very expensive. Corticosteroids cannot be considered useful therapy for GBS after two randomized controlled trials, one using conventional doses and the other high doses--500 mg methylprednisolone daily for five days. One pilot study on 25 patients has shown that combined treatment with high dose methylprednisolone and immunoglobulins was more effective than immunoglobulins alone. In the treatment of chronic polyradiculoneuritis corticosteroids do have a place. General medical care and supportive therapy in the intensive care unit are of the greatest importance.