"The bottom line here is that IVIg, or immunoglobulin infusion, is the preferred treatment for Guillain-Barré, depending on availability," says Eelco Wijdicks, M.D., a Mayo Clinic neurologist and second author of the paper. Availability of IVIg treatment is compromised at times by shortages of gamma globulin, Dr. Wijdicks notes.
Although both this treatment and the other major immunotherapy for Guillain-Barré Syndrome, plasma exchange, hasten recovery and are equally effective, IVIg is preferable to plasma exchange, according to the new recommendations. IVIg involves intravenously administering large dosages of normal antibodies from donated blood. Plasma exchange involves removing the plasma from a patient's blood, isolating it from the blood cells, replacing it with albumin, another blood product, and then putting the cells back into the body.
"There is no question that plasma exchange could have more complications," says Dr. Wijdicks. "Hypotension -- low blood pressure -- is possible. Catheter placement in large veins has a tendency to cause more complications. IVIg is easier to use and there are fewer complications. With evidence of comparable effect, it should be the treatment of choice."
Dr. Wijdicks also explains that in comparison with infusion plasma exchange is much more complicated logistically, and requires a specialized, experienced plasma exchange team.
Early treatment is key to the effectiveness of immunotherapy treatments, according to the expert panel that formed the Guillain-Barré Syndrome treatment recommendations. Guillain-Barré Syndrome can progress rapidly, leading to further deterioration and damage, and requires immediate hospitalization. If the patient receives either plasma exchange or IVIg within two weeks of the onset of symptoms of Guillain-Barré Syndrome, the chance for a better outcome improves.
The new guidelines for Guillain-Barré Syndrome treatment do not recommend combining plasma exchange and IVIg, as the outcome is not superior to either therapy alone. Additionally, steroid treatment with drugs such as prednisone, which had been a primary treatment for Guillain-Barré Syndrome, is ineffective. Data on combination therapies, using steroids combined with IVIg or two courses of IVIg or plasma exchange, is not currently available and may be promising. In some patients with initial good improvement but then worsening during the same hospital admission another course of immunotherapy may be needed. This scenario is not commonly seen in clinical practice and the patient may have another diagnosis, according to Dr. Wijdicks.
In Guillain-Barré Syndrome, a patient's own immune system spins out of control and attacks not only infections, but also the nerves critical for muscle strength, maintaining adequate breathing and stable blood pressure. When this condition develops, the patient may experience tingling sensations, numbness, weakness or difficulty breathing. Immunotherapy involves methods of blocking or ridding the body of damaging substances.
Guillain-Barré Syndrome typically is a one-time event, rather than a chronic condition. It annually affects 1 out of 100,000 people worldwide.
For more information on Guillain-Barré Syndrome, see http://www.mayoclinic.com/goto/?topic=gbs .
Lisa Copeland
507-284-5005 (days)
507-284-2511 (evenings)
e-mail: newsbureau@mayo.edu
Journal
Neurology