title: Is a second cycle of immunoglobulin justified in axonal forms of Guillain-Barré syndrome?
abstract: Objective In certain situations, severe forms of Guillain-Barré syndrome (GBS) show no response or continue to deteriorate after intravenous immunoglobulin (IVIg) infusion. It is unclear what the best treatment option would be in these circumstances.Method This is a case report on patients with severe axonal GBS in whom a second cycle of IVIg was used.Results Three patients on mechanical ventilation who presented axonal variants of GBS, with autonomic dysfunction, bulbar impairment and Erasmus score > 6, showed no improvement after IVIg infusion of 400 mg/kg/d for 5 days. After 6 weeks, we started a second cycle of IVIg using the same doses and regimen as in the previous one. On average, 5 days after the second infusion, all the patients were weaned off mechanical ventilation and showed resolution of their blood pressure and heart rate fluctuations.Conclusions A second cycle of IVIg may be an option for treating severe forms of GBS.
authors.affiliation: Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, AR.
authors.forename: Daniel Agustin
authors.initials: DA
authors.lastname: Godoy
authors.affiliation: Neuroscience Critical Care Unit, Mayo Clinic, Rochester, Minnesota, US.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rabinstein
mesh_terms: D001369:Axons; D005260:Female; D020275:Guillain-Barre Syndrome / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors