title: The role of immunotherapy in Guillain-Barré syndrome: understanding the mechanism of action.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis and, despite treatment, there continues to be an associated mortality and severe disability ranging from 9 to 17%. This article reviews the rationale behind the existing immunotherapy in GBS and discusses the future direction that work in this area should follow.
  
  
  METHODS
  The pathogenesis of GBS and the current evidence for the different forms of immunotherapy in GBS are reviewed. The proposed mechanism of action of each treatment--(steroids, plasma exchange and intravenous immunoglobulin (IVIG))--in GBS are discussed.
  
  
  CONCLUSIONS
  Both plasma exchange and IVIG are equally effective in GBS although the latter is preferred in view of its ease of access and lower rates of complications. Although not clinically established, there may be a role for the concomitant use of steroids with IVIG and, in patients with severe disease and poor prognostic scores, plasma exchange followed by IVIG or two successive IVIG may prove beneficial.
authors.affiliation: University of Malaya, Faculty of Medicine, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Nortina
authors.initials: N
authors.lastname: Shahrizaila
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Yuki
mesh_terms: D000818:Animals; D003131:Combined Modality Therapy; D005938:Glucocorticoids / Q000627:therapeutic use*; D020275:Guillain-Barre Syndrome / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods; D010951:Plasma Exchange / Q000379:methods*; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous