Treatment of Guillain-Barre syndrome with intravenous immunoglobulin

Guillain-Barre. syndrome (GBS) is an acute polyneuropathy that typically pr esents as a progressive flaccid paralysis. The pathology is believed to be caused by both cellular and humoral immune processes. This inflammatory neu ropathy has a mortality rate of 4-5%. About 30% of patients require mechani cal ventilation, and these patients are often hospitalized for months befor e regaining the ability to walk. Immunomodulation is used to improve the re covery rate and shorten hospital stays. Plasma exchange was shown to be eff ective in improving recovery time in GBS in several controlled trials durin g the 1980s. In this decade, intravenous immunoglobulin (Mg) therapy has be en shown to be equally effective for therapy of GBS and its variants. Altho ugh the precise mechanisms of immunomodulation by Mg are unknown, it probab ly directly inactivates specific anti-myelin antibodies and indirectly inhi bits their production. Mg offers some advantages over plasma exchange by be ing better tolerated in some patients and being easily administered without special equipment. However, because of the possibility of progression, the treatment of GBS patients requires qualified neurologic and supportive car e.