Guillain-Barré syndrome medical therapy: Difference between revisions
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{{Guillain-Barré syndrome}} | {{Guillain-Barré syndrome}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Fs}} | ||
==Overview== | ==Overview== | ||
Supportive therapy for Guillain Barre syndrome include: Respiratory assistance, [[Heart rate]] and [[blood pressure]] monitoring, prevention of [[Thromboembolic disorders|thromboembolic]] complications by [[heparin]], minimal sedation in intensive care units, [[pain]] control and early passive movements. [[Immunomodulators|Immunomodulating]] therapy for Guillain Barre syndrome include: [[Plasma]] exchange, High dose [[immunoglobulin]] and [[Corticosteroids]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
* Treatment for Guillan Barre syndrome can be divided into two groups: | * Treatment for Guillan Barre syndrome can be divided into two groups: | ||
** Supportive therapy: | ** Supportive therapy: | ||
*** Respiratory assistance: We measure maximal expiratory vital capacity and if vital capacity falls under 15 ml/kg, we start mechanical ventilation and endotracheal intubation. | *** Respiratory assistance: We measure maximal expiratory [[vital capacity]] and if [[vital capacity]] falls under 15 ml/kg, we start [[mechanical ventilation]] and [[endotracheal intubation]]. | ||
*** Heart rate and blood pressure monitoring. | *** [[Heart rate]] and [[blood pressure]] monitoring. | ||
*** Prevention of thromboembolic complications by heparin. | *** Prevention of [[Thromboembolic disorders|thromboembolic]] complications by [[heparin]]. | ||
*** Reduce respiratory infections by minimal sedation in intensive care units. | *** Reduce respiratory infections by minimal sedation in intensive care units. | ||
*** Pain control by analgesics. | *** [[Pain]] control by [[analgesics]]. | ||
*** Prevention of contracture by early passive movement. | *** Prevention of contracture by early passive movement. | ||
** Immunomodulating therapy | ** [[Immunomodulators|Immunomodulating]] therapy | ||
*** Plasma exchange: It is proved in so many studies that plasma exchange is an effective treatment option and can reduce recovery time.<ref name="pmid2893583">{{cite journal |vauthors= |title=Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome |journal=Ann. Neurol. |volume=22 |issue=6 |pages=753–61 |date=December 1987 |pmid=2893583 |doi=10.1002/ana.410220612 |url=}}</ref><ref name="pmid1642477">{{cite journal |vauthors= |title=Plasma exchange in Guillain-Barré syndrome: one-year follow-up. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome |journal=Ann. Neurol. |volume=32 |issue=1 |pages=94–7 |date=July 1992 |pmid=1642477 |doi=10.1002/ana.410320115 |url=}}</ref> | *** [[Plasma]] exchange: It is proved in so many studies that [[plasma]] exchange is an effective treatment option and can reduce recovery time.<ref name="pmid2893583">{{cite journal |vauthors= |title=Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome |journal=Ann. Neurol. |volume=22 |issue=6 |pages=753–61 |date=December 1987 |pmid=2893583 |doi=10.1002/ana.410220612 |url=}}</ref><ref name="pmid1642477">{{cite journal |vauthors= |title=Plasma exchange in Guillain-Barré syndrome: one-year follow-up. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome |journal=Ann. Neurol. |volume=32 |issue=1 |pages=94–7 |date=July 1992 |pmid=1642477 |doi=10.1002/ana.410320115 |url=}}</ref> | ||
*** High dose immunoglobulin: IVIG is as effective as plasma exchange for treatment of GBS. Combination therapy with these two will not result in a netter outcome.<ref name="pmid1552913">{{cite journal |vauthors=van der Meché FG, Schmitz PI |title=A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group |journal=N. Engl. J. Med. |volume=326 |issue=17 |pages=1123–9 |date=April 1992 |pmid=1552913 |doi=10.1056/NEJM199204233261705 |url=}}</ref><ref name="pmid12499466">{{cite journal |vauthors=Dalakas MC |title=Mechanisms of action of IVIg and therapeutic considerations in the treatment of acute and chronic demyelinating neuropathies |journal=Neurology |volume=59 |issue=12 Suppl 6 |pages=S13–21 |date=December 2002 |pmid=12499466 |doi= |url=}}</ref> | *** High dose [[immunoglobulin]]: [[IVIG]] is as effective as plasma exchange for treatment of GBS. Combination therapy with these two will not result in a netter outcome.<ref name="pmid1552913">{{cite journal |vauthors=van der Meché FG, Schmitz PI |title=A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group |journal=N. Engl. J. Med. |volume=326 |issue=17 |pages=1123–9 |date=April 1992 |pmid=1552913 |doi=10.1056/NEJM199204233261705 |url=}}</ref><ref name="pmid12499466">{{cite journal |vauthors=Dalakas MC |title=Mechanisms of action of IVIg and therapeutic considerations in the treatment of acute and chronic demyelinating neuropathies |journal=Neurology |volume=59 |issue=12 Suppl 6 |pages=S13–21 |date=December 2002 |pmid=12499466 |doi= |url=}}</ref> | ||
*** Corticosteroids: | *** [[Corticosteroids]]: | ||
**** In some animal models it was demonstrated that corticosteroids reduce allergic neuritis.<ref name="pmid3260088">{{cite journal |vauthors=Heininger K, Schäfer B, Hartung HP, Fierz W, Linington C, Toyka KV |title=The role of macrophages in experimental autoimmune neuritis induced by a P2-specific T-cell line |journal=Ann. Neurol. |volume=23 |issue=4 |pages=326–31 |date=April 1988 |pmid=3260088 |doi=10.1002/ana.410230403 |url=}}</ref> | **** In some animal models it was demonstrated that [[corticosteroids]] reduce allergic [[neuritis]].<ref name="pmid3260088">{{cite journal |vauthors=Heininger K, Schäfer B, Hartung HP, Fierz W, Linington C, Toyka KV |title=The role of macrophages in experimental autoimmune neuritis induced by a P2-specific T-cell line |journal=Ann. Neurol. |volume=23 |issue=4 |pages=326–31 |date=April 1988 |pmid=3260088 |doi=10.1002/ana.410230403 |url=}}</ref> | ||
**** In another study it was demonstrated that treatment with corticosteroids alone is not effective.<ref name="pmid22786476">{{cite journal |vauthors=Hughes RA, Swan AV, van Doorn PA |title=Intravenous immunoglobulin for Guillain-Barré syndrome |journal=Cochrane Database Syst Rev |volume= |issue=7 |pages=CD002063 |date=July 2012 |pmid=22786476 |doi=10.1002/14651858.CD002063.pub5 |url=}}</ref> | **** In another study it was demonstrated that treatment with [[corticosteroids]] alone is not effective.<ref name="pmid22786476">{{cite journal |vauthors=Hughes RA, Swan AV, van Doorn PA |title=Intravenous immunoglobulin for Guillain-Barré syndrome |journal=Cochrane Database Syst Rev |volume= |issue=7 |pages=CD002063 |date=July 2012 |pmid=22786476 |doi=10.1002/14651858.CD002063.pub5 |url=}}</ref> | ||
**** In a randomized study it was demonstrated that the combination of IVIG and corticosteroid will not result in any advantage.<ref name="pmid14738791">{{cite journal |vauthors=van Koningsveld R, Schmitz PI, Meché FG, Visser LH, Meulstee J, van Doorn PA |title=Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial |journal=Lancet |volume=363 |issue=9404 |pages=192–6 |date=January 2004 |pmid=14738791 |doi= |url=}}</ref> | **** In a randomized study it was demonstrated that the combination of [[IVIG]] and [[corticosteroid]] will not result in any advantage.<ref name="pmid14738791">{{cite journal |vauthors=van Koningsveld R, Schmitz PI, Meché FG, Visser LH, Meulstee J, van Doorn PA |title=Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial |journal=Lancet |volume=363 |issue=9404 |pages=192–6 |date=January 2004 |pmid=14738791 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 17:21, 27 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Supportive therapy for Guillain Barre syndrome include: Respiratory assistance, Heart rate and blood pressure monitoring, prevention of thromboembolic complications by heparin, minimal sedation in intensive care units, pain control and early passive movements. Immunomodulating therapy for Guillain Barre syndrome include: Plasma exchange, High dose immunoglobulin and Corticosteroids.
Medical Therapy
- Treatment for Guillan Barre syndrome can be divided into two groups:
- Supportive therapy:
- Respiratory assistance: We measure maximal expiratory vital capacity and if vital capacity falls under 15 ml/kg, we start mechanical ventilation and endotracheal intubation.
- Heart rate and blood pressure monitoring.
- Prevention of thromboembolic complications by heparin.
- Reduce respiratory infections by minimal sedation in intensive care units.
- Pain control by analgesics.
- Prevention of contracture by early passive movement.
- Immunomodulating therapy
- Plasma exchange: It is proved in so many studies that plasma exchange is an effective treatment option and can reduce recovery time.[1][2]
- High dose immunoglobulin: IVIG is as effective as plasma exchange for treatment of GBS. Combination therapy with these two will not result in a netter outcome.[3][4]
- Corticosteroids:
- In some animal models it was demonstrated that corticosteroids reduce allergic neuritis.[5]
- In another study it was demonstrated that treatment with corticosteroids alone is not effective.[6]
- In a randomized study it was demonstrated that the combination of IVIG and corticosteroid will not result in any advantage.[7]
- Supportive therapy:
References
- ↑ "Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome". Ann. Neurol. 22 (6): 753–61. December 1987. doi:10.1002/ana.410220612. PMID 2893583.
- ↑ "Plasma exchange in Guillain-Barré syndrome: one-year follow-up. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome". Ann. Neurol. 32 (1): 94–7. July 1992. doi:10.1002/ana.410320115. PMID 1642477.
- ↑ van der Meché FG, Schmitz PI (April 1992). "A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group". N. Engl. J. Med. 326 (17): 1123–9. doi:10.1056/NEJM199204233261705. PMID 1552913.
- ↑ Dalakas MC (December 2002). "Mechanisms of action of IVIg and therapeutic considerations in the treatment of acute and chronic demyelinating neuropathies". Neurology. 59 (12 Suppl 6): S13–21. PMID 12499466.
- ↑ Heininger K, Schäfer B, Hartung HP, Fierz W, Linington C, Toyka KV (April 1988). "The role of macrophages in experimental autoimmune neuritis induced by a P2-specific T-cell line". Ann. Neurol. 23 (4): 326–31. doi:10.1002/ana.410230403. PMID 3260088.
- ↑ Hughes RA, Swan AV, van Doorn PA (July 2012). "Intravenous immunoglobulin for Guillain-Barré syndrome". Cochrane Database Syst Rev (7): CD002063. doi:10.1002/14651858.CD002063.pub5. PMID 22786476.
- ↑ van Koningsveld R, Schmitz PI, Meché FG, Visser LH, Meulstee J, van Doorn PA (January 2004). "Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial". Lancet. 363 (9404): 192–6. PMID 14738791.