Treatment of the Guillain-Barré syndrome

The Guillain-Barre syndrome (GBS) is an inflammatory polyneuropathy with an incidence of 1-1.8/100,000. It is characterised by an acute or subacute onset and a progressive phase of less than four weeks, followed by a plateau phase of variable duration [106, 111]. Improvement then starts spontaneously; about 80% of the patients revover completely [135]. During the disease, 10-23% of the patients require artificial ventilation and there is still a mortality of 3-5%. Ultimately, 10-22% of the patients remain disabled [106, 113, 135]. Since not all patients make an uneventful, complete recovery, the search for an effective treatment is going on continuously. The possible role of humoral components in the pathogenesis of GBS [30] prompted an open study with plasma exchange (PE) in a single patient with severe GBS. That was very successful [14]. After numerous case reports [28, 58, 109, 130, 141, 149, 172] and several clinical trials [50, 57, 61, 131] examining the effects of PE in GBS patients, PE is now generally accepted as a treatment for patients with severe GBS [26]. PE carries, however, certain risks [69, 159]. It is a cumbersome procedure and therefore not widely applicable. This prompted us to investigate an alternative treatment with immunoglobulins, given intravenously (Igiv), which forms the basis for this thesis. The aim of this study was to investigate a new, and relatively simple treatment for patients with Guillain-Barre syndrome (GBS).

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