Low‐cost alternatives for the management of Guillain‐Barré syndrome in low‐ and middle‐income countries

Abstract

Guillain‐Barré syndrome (GBS) is the most common cause of acute flaccid paralysis. It can cause rapidly progressing ascending paralysis leading to respiratory failure. There is no definite treatment for GBS, but early administration of intravenous immunoglobulin or therapeutic plasma exchange accelerates motor recovery and decreases time on the ventilator support and are considered the standard of care in GBS. However, these treatments are often unaffordable for many patients in low‐ and middle‐income countries, with limited availability and specialized expertise required in prescription. Cheaper alternatives such as modified therapeutic plasma exchange, exchange blood transfusion, rituximab, and pulse steroid therapy have been practiced in different parts of the world and have been shown to be effective, albeit with limited evidence. These cost‐effective therapies warrant further research and should be strongly considered by relevant health authorities and policymakers as a potential primary treatment for GBS in resource‐limited settings.

Pediatric Guillain–Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome

“… 3 , 24 Similarly, a Chinese study showed that incidence of the disease peaked in children aged 1–4 years. 7 In this study, the mean age of the participants (7.25±3.91 years) is in line with findings of other studies; 7 , 13 and 35.3% of them were under 5 years of age which is consistent with a report from China. 8 …”

“…3,24 Similarly, a Chinese study showed that incidence of the disease peaked in children aged 1-4 years. 7 In this study, the mean age of the participants (7.25±3.91 years) is in line with findings of other studies; 7,13 and 35.3% of them were under 5 years of age which is consistent with a report from China. 8 Some studies showed clustering in the incidence of GBS during certain seasons of the year: an observation that can be explained by the seasonality of certain triggers of GBS like gastroenteritis and influenza.…”

“…Though the evidence is limited, there are reports of effective use of cheaper alternatives such as modified therapeutic plasma exchange, exchange blood transfusion, rituximab, and pulse steroid therapy in the treatment of GBS. 13 …”

“…Though the evidence is limited, there are reports of effective use of cheaper alternatives such as modified therapeutic plasma exchange, exchange blood transfusion, rituximab, and pulse steroid therapy in the treatment of GBS. 13 Studies showed that about 20-30% of patients with GBS develop respiratory failure and require admission to intensive care unit (ICU). 1,14 However, the number of ICU beds is limited in low-income countries and patients that require ICU care often die.…”

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

“…Additionally, the utilization of small-volume TPE methods, whether through centrifugation or membrane separation, offers further cost savings and has been widely implemented in LMICs. 70 Another alternative is small-volume plasma exchange (SVPE) by sedimentation, which involves repeated removal of small volumes of plasma over several days using sedimentation of the patient's whole blood, eliminating the need for a centrifugation machine. The sedimented blood cells are then re-transfused to the patient along with normal saline and fresh frozen plasma as replacement fluid.…”