Intravenous Immunoglobulin for Guillain-Barré Syndrome: How Effective?

Abstract

Guillain-Barré syndrome is an acute inflammatory demyelinating neuropathy characterized by progressive symmetric polyradiculoneuritis, predominantly manifested by weakness and areflexia. In this article, we report our findings in 25 children treated with intravenous immunoglobulin and compare them with the remaining 30 children who received supportive care only. Only supportive care was given to 30 children who were not able to receive intravenous gammaglobulin because of shortcomings in intravenous gammaglobulin availability owing to a poor import during those years. Twenty-five patients were treated with intravenous gammaglobulin; they received intravenous gammaglobulin 0.4 g/kg/day for 5 consecutive days. Seventeen of the intravenous gammaglobulin group had received intravenous gammaglobulin within 10 days after the first symptoms, and eight of them had received intravenous gammaglobulin after the first 10 days. The average time elapsed for the symptoms to reach the maximum level was 6.9 (range 4-12) days in patients receiving intravenous gammaglobulin in the first 10 days, and it was significantly shorter than the time elapsed for the supportive care group (6.9 versus 8.8 days, respectively) (P < .05). Admission to the hospital after the first symptom, disability grade, time to improve in disability grade, the period of hospitalization, and mortality were not different in the intravenous gammaglobulin and supportive care groups (P > .05). Our suggestion for intravenous gammaglobulin treatment in Guillain-Barré syndrome is that if the patient has risk factors for respiratory insufficiency, then the treatment should be started. We more confidently carry out the follow-up of these patients after the results of this study. In conclusion, although it has been reported that intravenous gammaglobulin facilitates improvement in the disease and the decrease in mortality in children with Guillain-Barré syndrome, it has been mentioned in some studies that the intravenous gammaglobulin treatment was not better than supportive care, as in our study. However, further studies are essential to determine when intravenous gammaglobulin should be given to patients having which clinical and laboratory findings.

Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders

“…In summary, the evidence shows that IVIG reduced time to return of function in one RCT, one cohort study, and one series ( n =150), but not in one cohort study with increased disease severity in the IVIG arm ( n =55) . Treatment with 2g/kg of IVIG divided over 2 days did not affect overall outcome, but was associated with secondary transient deterioration compared with treatment over 5 days (5 out of 23 vs 0 out of 23; p =0.049) .…”

“…IVIG was associated with a longer duration of mechanical ventilation . A cohort study ( n =55) comparing IVIG with supportive care found no difference in maximal disability grade or time to improvement . Treatment was allocated according to IVIG availability, and the treatment group had higher rates of ventilation, mortality, and severe disability.…”

“…12 A cohort study (n=55) comparing IVIG with supportive care found no difference in maximal disability grade or time to improvement. 13 Treatment was allocated according to IVIG availability, and the treatment group had higher rates of ventilation, mortality, and severe disability. A similar cohort study (n=33) compared outcomes after IVIG treatment (n=22) with a matched comparison group treated supportively (n=11) when IVIG was not available.…”

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

“…One multicenter randomized study from Western Europe found that early treatment with IVIG was associated with earlier motor recovery [31]. Other studies show that IVIG was no better than supportive care, although the time from symptom onset to maximum symptom severity was shorter in patients who received IVIG within 10 days than patients who did not receive IVIG [32]. Both efficacy and non-efficacy have been documented in children with GBS, and most of these studies are limited by small study design.…”

Clinical and Laboratory Features, Treatment and Prognosis in Children with Guillian-Barre Syndrome

“…Тем не менее, в детской популяции по миру не отмечена разница в полноте восстановления между формами СГБ спустя год после начала заболевания. Дети, перенесшие как ОВДП, так и ОМАН/ ОМСАН, имеют очень хороший прогноз в плане восстановления двигательных функций [10,11]. Имеются ли различия в протекании аксональных и демиелинизирующих форм у детей в нашей стране, в настоящее время не известно.…”