Treatment of Guillain-Barré syndrome with intravenous immunoglobulin.

Guillain-Barré syndrome (GBS) is an acute polyneuropathy that typically presents as a progressive flaccid paralysis. The pathology is believed to be caused by both cellular and humoral immune processes. This inflammatory neuropathy has a mortality rate of 4-5%. About 30% of patients require mechanical ventilation, and these patients are often hospitalized for months before regaining the ability to walk. Immunomodulation is used to improve the recovery rate and shorten hospital stays. Plasma exchange was shown to be effective in improving recovery time in GBS in several controlled trials during the 1980s. In this decade, intravenous immunoglobulin (IVIg) therapy has been shown to be equally effective for therapy of GBS and its variants. Although the precise mechanisms of immunomodulation by IVIg are unknown, it probably directly inactivates specific anti-myelin antibodies and indirectly inhibits their production. IVIg offers some advantages over plasma exchange by being better tolerated in some patients and being easily administered without special equipment. However, because of the possibility of progression, the treatment of GBS patients requires qualified neurologic and supportive care.