[Treatment of Guillain-Barré syndrome in adults: role of plasma exchange].
OBJECTIVE
To review recent data on treatment of Guillain-Barré syndrome, especially indications of plasma exchange.


RESULTS
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis. The current mortality is 5%, sever motor sequelae persist after 1 year in 10% of cases. Multidisciplinary teams are required to treat these patients, trained to all specific treatments. Oral and intravenous steroids have proven ineffective. Two large randomized clinical trials comparing plasma exchange (PE) with no treatment have shown a short-term and a 1-year benefit. Appropriate number of exchanges and indications are now more precisely known. In mild form (walking possible), patients should receive two PEs. A further two exchanges should be done in case of deterioration or in advanced forms (loss of walking ability, mechanical ventilation). More exchanges are not beneficial. Recently two new randomized trials have produced evidence that intravenous immune globulin (IVIg) (0.4 g/kg/d for 5 days) were as effective as five PEs in advanced forms. The combination of PE with IVIg did not confer a significant advantage, while increasing cost and risks.


CONCLUSIONS
The combination of PE with IVIg did not confer, in advanced forms, the choice between PE and IVIg depends of the contra-indications of each treatment.
Service de réanimation médicale, hôpital Raymond-Poincaré, Garches.
J C
JC
Raphael
S
S
Chevret
I
I
Auriant
T
T
Sharshar
J
J
Bouget
F
F
Bolgert
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D003131:Combined Modality Therapy; D000075202:Contraindications; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D010951:Plasma Exchange; D011129:Polyradiculoneuropathy / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous
Les traitements du syndrome de Guillain-Barré de l'adulte: place des échanges plasmatiques.