Treatment of the adult Guillain-Barre syndrome: indications for plasma exchange

The Guillain-Barre syndrome is the most common cause of acute flaccid paral ysis. Currently, 5% of patients die and 10% are left with severe motor sequ elae at one year. Multidisciplinary teams, trained to specific treatments, are required to manage these patients. Oral and intravenous steroid treatme nt of GBS has been disappointing. Two large randomized clinical trials comp aring plasma exchange (PE) to standard supportive treatment have shown a sh ort-term and a one-year benefit of PE. Appropriate number of exchanges and indications of PE are now more precisely known. Patients with mild forms of the disease table to walk) should receive two PEs, while a further two exc hanges should be done in case of deterioration or in advanced forms (loss o f walking ability, mechanical ventilation). A greater number of exchanges d oes not appeared beneficial. More recently, two randomized trials produced some evidence that intravenous immune globulin (IVIg, 0.4 g/kg daily for fi ve days) and PE had equivalent efficiency in advanced forms. The combinatio n of PE with IVIg did not yield a significant advantage, but did increase c ost and risk. In advanced forms, the choice between PE and IVIg depends on the contraindications of each treatment. (C) 1999 Elsevier Science Ltd. All rights reserved.