[Present treatment of Guillain-Barre syndrome].
The annual incidence of Guillain-Barré Syndrome is 1.5 per 100,000. The mortality rate is about 5%, and 10% of patients remain severely disabled one year after neurological onset. Specialist teams, intensive care and rehabilitation are essential for patient management and should be provided in appropriate hospital units. Neither oral nor intravenous corticosteroids are beneficial. Plasma exchange (PE) is the first-line treatment, improving outcome in several randomised, controlled clinical trials. The indications for treatment have been clarified. Two PE sessions are recommended for patients who are able to walk (mild forms), with two additional sessions if they deteriorate. Four sessions are sufficient for patients who are unable to walk unaided (moderate) or who require mechanical ventilation (severe). Further PE sessions are not helpful for patients with more severe disease, or if there is no response. High-dose intravenous immunoglobulins (0.4 g/kg daily for 5 days) and PE are equally effective in patients with intermediate and severe forms. The choice between the two treatments depends on their respective contraindications and local availability. A trial is underway to determine the indications and optimal dose of IVIg and the optimal number of PE sessions in the different disease severities.
Raphaël
Jean-Claude
JC
Service de Reanimation Médicale, Hôpital Raymond Poincaré, 92380 Garches. jean-claude.raphael@rpc.ap-hop-paris.fr
D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D020275:Guillain-Barre Syndrome / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D010951:Plasma Exchange; D011379:Prognosis
D016756:Immunoglobulins, Intravenous
Le traitement actuel du syndrome de Guillain-Barré.