Management of Guillain–Barré syndrome with plasmapheresis or immunoglobulin: our experience from a tertiary care institute in South India

Abstract

Guillain-Barré syndrome (GBS), an acute inflammatory demyelinating polyneuropathy is the most common generalized paralytic disorder. The objective was to study the outcome of disability grade in two groups of GBS treated with plasmapheresis alone and treated with IVIg alone. A retrospective analysis of all consecutive patients with GBS, admitted in our intensive care unit during the period of 3 years, 2009-2012 were included in the study. All patients of GBS who were to be treated with plasmapheresis or IVIg, the modality of management were always decided at their preference and consent after explaining the modalities to patient/family. The plasma exchange done was $200-250 mL of plasma per kilogram weight in five sessions (40-50 mL/kg per session) within 7-14 days. The replacement fluid contained 100 mL of 20% albumin diluted in 1000 mL of normal saline and 1000 mL of fresh frozen plasma. IVIg was administered as 0.4 g/kg body weight daily for 5 days. Our observations brought out the following, both the plasmapheresis and IVIg treatments were effective in reducing the disability grade amongst all time points, i.e., at presentation, immediate post-therapy and after 4 weeks. There was a marginal superiority in plasmapheresis over IVIg effect. However, whether the delay in presentation as noted in our study probably would have contributed to this effect was conjectural.

Change in therapeutic apheresis practices: Role of continuing medical education (CME)

“…Fewer adverse reactions were in concert with change in the replacement fluid which was very similar to the findings of Basic‐Jukic et al and Shemin et al . This study is important because there is limited data about apheresis education in the Indian literature .…”

“…In India, according to the published report most common indications for which therapeutic apheresis has been performed are Acute Inflammatory Demyelinating Polyneuropathy/Guillain–Barre syndrome (AIDP/GBS), Myasthenia gravis (MG), leukocytosis/thrombocytosis and atypical hemolytic uremic syndrome (aHUS). In the last couple of decades there has been a remarkable increase in number of centers practicing therapeutic apheresis in India as evidenced by several publications on this subject .…”

A study on therapeutic plasma exchange using apheresis in treatment of Guillain-Barré syndrome in a tertiary care teaching hospital

“…76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with Kishore et al and Basic-Jukic et al 30% of patients suffered complications which was comparable with various other studies. 11,12 The limitations of the study is that it is a single centre study and a retrospective study with comparatively less number of study subjects. Based on results published by various other studies, ttherapeutic plasma exchange is a comparatively a safe and effective procedure.…”

Long-term prognosis of Guillain-Barré syndrome not determined by treatment options?

“…Intravenous immunoglobulins (IVIg) and plasma exchange are two most effective treatments while the use of steroids is not thought to be beneficial [ 12 ]. Six large comparative studies between IVIg and plasma exchange have been conducted on GBS patients, whereas plasma exchange and IVIg were found as equally effective [ 13 , 14 ]. Of note are the flaws of the above-mentioned studies.…”

“…Seemingly, a majority of patients with GBS experience a quick recovery within one year after the acute phase [ 2 ]. Thus, most of the follow-up studies are stopped at the first year after discharge, and the effect of IVIg is also explored based on the one-year follow-up data [ 13 , 14 ]. However, residual deficits do exist among GBS patients [ 2 ].…”