Effectiveness of Intravenous Immunoglobulin (IVIG) Therapy in Treatment of Guillain-Barré Syndrome(GBS)
The management of GBS consists of both supportive and immunomodulatory treatments, of which intravenous immunoglobulin (IVIG) and plasmapheresis (PP) are considered most effective. A number of randomized, controlled studies have shown IVIG to be at least as effective as plasmapheresis in the treatment of GBS, and in some cases, superior. The choice of treatment for individual patients is undertaken by the patient's physician, based on the patient's condition, and sometimes on the hospital at which the patient is being treated.
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Not all hospitals have the equipment and personnel required to offer plasmapheresis, besides which the method is difficult to administer to elderly patients and those with poor venous access. IVIG is more convenient to administer and receive, and has therefore often replaced plasmapheresis as the preferred treatment. It can be administered at most hospitals and can be administered as a 4 to 6 hour infusion. Also, IVIG does not remove other useful components that are in the blood and can be less costly and has less problems than does plasmapheresis.Moreover, IVIG has been found to be safer than plasmapheresis, having a lower frequency of complications. IVIG has also been found to be effective and safe in the treatment of pediatric patients with GBS[1,2]. Thus, its efficacy, safety, and availability make it the treatment of choice in many patients with GBS.
Some evidence suggests that in select patients who do not respond initially to IVIG, a second dose may be beneficial. However, this is not currently standard therapy and warrants further investigation.
What is the IVIG dose for treatment of GBS?
Usually, the starting dose is 2 grams per Kilogram of patient weight, given in 5 divided dosages over 5 days. Further doses are based on patient response. The IVIG effect on GBS may be seen in a few days and may last for several weeks to months. Some patients may need further doses in the future if symptoms return.
How is IVIG treatment given?
IVIG is given as an intravenous drip.
What are the side-effects or adverse rections of IVIG treatment?
In general, IVIG is considered safe. Patients may experience mild side-effects including headaches, stiffness of the neck, nausea, dizziness, vomiting, chills, fever, low blood-pressure and arrhythmia for upto 48 hours after being treated, or in the initial stages of the treatment. These symptoms disappear after a few hours or days. If they occur during the treatment, they can be minimised by reducing the rate of IVIG infusion.
The treatment can also trigger allergic reactions, such as a rash on the palms of the hands. Serious complications, seldomly seen in otherwise healthy patients, include kidney damage and the formation of blood clots.
1.Hughes RA, Wijdicks EF, Barohn R, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Sep 23 2003;61(6):736-40.
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