[Immunoglobulins or plasma exchange? Guillain-Barré syndrome: indications for plasma exchange and immunoglobulins].
The effect of plasma exchange (PE) in the Guillain-Barré syndrome (GBS) has been evaluated in 4 randomized clinical trials. A positive effect could be excluded in only one study conducted in Great Britain which included 29 patients. The more powerful studies conducted in Sweden (39 patients), in North America (245 patients) and in France (220 patients) demonstrated that early use of four PEs in patients with a GBS severe enough to require assistance in walking was followed by decreased duration and severity of the acute phase. These conclusions were ratified at a North American consensus conference. More recently, PE has been demonstrated to increase the number of patients who recover normal muscular power after a 1-year follow-up. The French trial also demonstrated that diluted albumin should be preferred over fresh frozen plasma. The number of plasma exchanges and the role of PE in initially benign forms is of great importance and is now under study by a cooperative group in France. The effect of immunoglobulins (IgG) was recently investigated in a randomized trial including 150 patients. In this study, high doses (0.4 g/kg/day for 5 days) were compared with 5 PE administered between days 7 and 14 in children and adults who, at inclusion, were unable to walk. The main result was that the outcome at one month was good with IgG as with PE. Treatment is easier with IgG, and morbidity is lower. Direct costs are similar. If IgG are shown to be as effective as PE, IgG should be given for GBS.(ABSTRACT TRUNCATED AT 250 WORDS)
Raphaël
J C
JC
Service de Réanimation Médicale, Hôpital Raymond Poincare, Garches.
Chevret
S
S
Jars-Guincestre
M C
MC
Chastang
C
C
Gajdos
P
P
D000075202:Contraindications; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D010951:Plasma Exchange / Q000009:adverse effects / Q000401:mortality; D011129:Polyradiculoneuropathy / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
D016756:Immunoglobulins, Intravenous
Immunoglobulines ou échanges plasmatiques? Syndrome de Guillain-Barré: indications respectives des échanges plasmatiques et des immunoglobulines.