Intravenous immune globulin in the Guillain-Barré syndrome.

Guillain-Barré syndrome is an acute immune-mediated polyneuropathy with a severe clinical course. Plasma exchange (PE) was the first proven effective treatment ameliorating morbidity and outcome. However, it is not readily available and contraindications and complications frequently occur. High-dose intravenous immune globulin (IVIG) was demonstrated recently to be at least as effective and possibly more effective. The evidence is summarized in this article. Although specific treatment is now available, a proportion of patients do deteriorate with either IVIG (25%) or PE (34%) over the first 2 weeks after onset of treatment. A new dilemma has therefore arisen: is it worthwhile to switch therapy in patients who show further deterioration during therapy? As will be discussed, only a pragmatic approach is possible for the moment. In general it will be most effective to give just one full dose of IVIG or, alternatively, a full course of PE. More effective treatments are still being developed. The results of a pilot study of IVIG combined with high-dose methyl-prednisolone are promising and warrant a large scale clinical trial for further confirmation.