TREATMENT OF ACUTE GUILLAIN-BARRE-SYNDROM E

The Guillain-Barre syndrome (GBS) is the most common cause of acute pa ralysis. It requires early institution of therapy to avoid life-threat ening complications, to speed up recovery and minimize residual handic ap. Advances in supportive care (treatment of infections, anticoagulat ion) and the introduction of intensive care (assisted ventilation, tre atment of autonomic disturbances) have greatly improved the management of this disease and consequently its prognosis. A better understandin g of the underlying immune mechanisms prompted pathogenetically orient ed therapy. Plasma exchange and high dose intravenous immunoglobulin h ave been demonstrated in large controlled trials to hasten recovery in GBS. Problems of these studies are discussed and the presumed mode of action of these therapies is reviewed. Corticosteroids have shown no benefit. Ongoing trials are listed and future strategies for immunoint ervention are outlined.