The place of high dose immunoglobulins in the treatment of Guillain-Barré patients based upon the dutch trial.

The preliminary results of a multicenter trial in the Netherlands comparing plasma exchange (PE) with high-dose intravenous immunoglobulin (IgIV) (dose 0.4 g/kg during 5 consecutive days, total dose of 2.0 g/kg) are reported. The trial was performed on 150 patients. After 4 weeks, 34.2% of the PE patients and 52.7% of the IgIV patients showed improvement. While in 11 patients plasma exchange had to be discontinued for medical reasons, no serious side effects were seen in the high-dose immunoglobulin treatment group. In 30% of the patients antibodies to GM1 ganglioside were found. The presence of such antibodies was correlated with a more severe clinical course and delayed recovery. Since improvement in the IgIV group occurred almost twice as often in GM1 negative patients, the effect appears to be limited in GM1-positive patients, who obviously need additional treatment. A current multicenter trial uses IgIV combined with high-dose methylprednisolone.