GUILLAN-BARRE-SYNDROME IN THE ADULT - THERAPEUTIC ASPECTS

The Guillain-Barre syndrome is the most common cause of acute flaccid paralysis. The current mortality is 5%, while severe moor sequelae per sist after one year in 10%. Multidisciplinary teams, trained in all sp ecific treatments, are required to treat these patients. Oral and intr avenous steroids have proved ineffective. Two large randomized clinica l trials com paring plasma exchange (PE) with no treatment have shown a short-term and a 1-year benefit. The appropriate number of exchanges and the indications are now more precisely known. In the mild form (w alking possible) patients should receive two PEs; a further two exchan ges should be done in the event of deterioration or in advanced forms (loss of walking ability, mechanical ventilation). More exchanges are not beneficial. Recently two new randomized trials have produced evide nce that intravenous immunoglobulin (IVIg) (0.4 g/kg/day for 5 days) w as as effective as 5 PEs in advanced forms. The combination of PE with IVIg did not confer a significant advantage but increased the costs a nd risks. In advanced forms the choice between PE and Mg depends on th e contraindications for each treatment.