Rescue treatment in patients with poorly responsive Guillain–Barre syndrome

Abstract

Objectives:To evaluate the effectiveness of rescue treatment (intravenous immunoglobulin or plasma exchange) in patients with Guillain–Barre syndrome who did not respond or deteriorated after the initial management with intravenous immunoglobulin.Methods:We performed a retrospective review of the medical records of patients who responded poorly or did not respond to intravenous immunoglobulin treatment. The disability parameters of those who received second-line treatment with intravenous immunoglobulin or plasma exchange (20 patients) were compared with those who did not receive second-line treatment (19 patients).Results:There was a statistically significant improvement in disability scores at 1 month in the patients who received the rescue treatment (p = 0.033). However, there was no significant difference in the disability scores at 3 and 6 months, or in length of intensive care unit stay.Conclusion:Our study showed that a second course of treatment to carefully selected patients may be beneficial

Immunotherapy in Pediatric Guillain-Barré Syndrome: Intravenous Immunoglobulin, Plasmapheresis, Both or Something Else?

“…2,4,43,46 One point that needs to be clarified is when the first line of treatment is not successful what should be the correct approach, even because there is a study stating that the patients submitted to a second course of therapy had a lengthier hospital stay and slower motor recovery (nevertheless, there could be some improvement at the end of the first month of treatment, although at 3 and 6 months the differences were not significant, with a large amount of loss to follow-up). 27 There are not many studies, particularly in children, where both PLEX and IgIV are used simultaneously. In one of the few early articles 47 there were no significant differences between using each technique alone or in combination.…”

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“…2,4,43,46 One point that needs to be clarified is when the first line of treatment is not successful what should be the correct approach, even because there is a study stating that the patients submitted to a second course of therapy had a lengthier hospital stay and slower motor recovery (nevertheless, there could be some improvement at the end of the first month of treatment, although at 3 and 6 months the differences were not significant, with a large amount of loss to follow-up). 27 There are not many studies, particularly in children, where both PLEX and IgIV are used simultaneously. In one of the few early articles 47 there were no significant differences between using each technique alone or in combination.…”

“…So, a second line of treatment is still not well established, if the first course of treatment proves to be unsuccessful. 27…”

Are Repeated Cycles of Intravenous Immunoglobulin Justified in Patients With Poorly Responsive Guillain-Barré Syndrome?

“…Another study done by Godoy and Rabinstein 27 recommended a second cycle of IVIG for treating severe forms of GBS. A third study by Alboudi et al 28 concluded that a second course of rescue treatment using either IVIG or PLEX might be beneficial in carefully selected patients. Based on our experience and during discussions with neurologists in other centers, it is a common practice to give additional doses of IVIG for refractory cases or possible early chronic inflammatory demyelinating polyneuropathy.…”