MANAGEMENT OF ACUTE NEUROMUSCULAR PARALYSIS

The diagnosis of acute neuromuscular paralysis includes central nervou s system disorders, peripheral neuropathy, neuromuscular conduction bl ock and muscle disease. Identification of the cause is largely a clini cal problem but neurophysiological investigations are often essential and a few specific tests are helpful. The commonest cause is Guillain- Barre syndrome. Special precautions, especially monitoring vital capac ity, must be taken to detect respiratory failure and avoid atelectasis and chest infection. In acute neuropathy there is an additional dange r of cardiac arrhythmias which requires continuous electrocardiographi c monitoring. Prolonged artificial ventilation should be supervised by a specialist multidisciplinary intensive care team. Specific treatmen t depends on the diagnosis: for Guillain-Barre syndrome, intravenous i mmunoglobulin is preferred to plasma exchange on the basis of similar efficacy but greater convenience; steroids are not helpful; for myasth enia gravis, anticholinesterases and prednisolone may need to be suppl emented with intravenous immunoglobulin or plasma exchange; for polymy ositis, steroids are the mainstay of treatment. During convalescence p atients require understanding and support in coping with residual disa bility.