Treatment should begin within two to four weeks after the first symptoms appear. Guillain-Barré syndrome (GBS) causes rapid onset of weakness and often paralysis of the legs, arms, face and breathing muscles. It is the most common cause of rapidly acquired paralysis in the United States, affecting between one and four people in every 100,000 each year.
Guillain-Barré is an autoimmune disease in which the body's immune system attacks the nervous system. The human body produces proteins called antibodies to fight off infections. In GBS, the body produces extra antibodies that become misdirected and attack and damage the nerves.
The guideline examined all of the scientific research on the disorder in order to determine which treatments were most effective.
The review of the evidence found that two treatments – plasma exchange and intravenous immunoglobulin (IVIg) – are equally beneficial for adults with severe, early GBS. These treatments could also be considered for treating children with severe GBS.
"This means that people who are severely affected should be treated early with either IVIg or plasma exchange," said guidelines co-author Richard Hughes, MD, of Guy's, King's and St. Thomas' School of Medicine in London, England. "Neurologists and their patients should consider that IVIg has somewhat fewer side effects and is more convenient."
IVIg is a medication given intravenously. Immunoglobulin is a protein in human blood that helps the body find and destroy unfamiliar substances, such as viruses. In plasma exchange, blood is removed from the body and the plasma is separated from the red and white blood cells. Because plasma carries antibodies that can cause the disorder, the plasma is removed and replaced with a salt and protein solution before the blood goes back into the body.
The guideline also determined that there is no benefit from combining IVIg and plasma exchange, or performing one treatment after the other.
Another treatment, corticosteroids, or cortisone, was not found to be beneficial and is not recommended in the treatment of Guillain-Barré patients.
The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.
For more information about the guideline or the American Academy of Neurology, visit its web site at www.aan.com.
Journal
Neurology