All of the following statements regarding treatment of GBS are true, except -
Ans. is 'a' i.e., Corticosteroids may be used for early recovery and prevent long hospital stay o Glucocorticoids have not been found to be effective in Guillain-Barre Syndrome.Management of Guillain Barre Syndromeo Supportive care is extremely important in Guillain-Barre syndrome (GBS) since up to 30 percent of patients develop neuromuscular respiratory failure requiring mechanical ventilation.# In addition, severe autonomic dysfunction occurs in about 20percent and warrants intensive care unit (ICU) monitoring.Supportive managemento Close respiratory monitoring with frequent measurement of vital capacity and negative inspiratory force should be instituted in all patients with GBS on admission and continued while weakness is progressing, o Patients with a forced vital capacity <20 mL/kg, maximum inspiratory pressure <30 cmH2O, or maximum expiratory pressure <40 cmH2O are at high risk of impending respiratory failure and should undergo urgent intubation and mechanical ventilation.o In the absence of disease-modifying treatment, most patients with GBS show continued progression for up to two weeks, followed by a plateau phase of about two weeks, and then recovery offunction over several weeks to months.Disease modifying treatmento The main modalities of therapy for Guillain-Barre syndrome (GBS) include :# Plasma exchange (also called plasmapheresis)# Administration of intravenous immune globulin (IVIG).o Plasmapheresis is thought to remove circulating antibodies, complementr and soluble biological response modifiers.o The precise mechanism of action for IVIG in GBS is unknown but may include providing anti-idiotypic antibodies, modulating expression and function of Fc receptors, interfering with activation of complement and production of cytokines, and interfering with activation and effector functions of T and B cells.Plasmapheresiso With plasma exchange there is early improvement in muscle strength and reduced need for mechanical ventilation and better recovery.Intravenous immune globulino IVIG is as effective as plasma exchange for the treatment of GBS.o Patients with more severe clinical disease may benefit from longer duration of IVIG treatment.Choice of therapyo Disease-modifying therapy with plasma exchange or IVIG is recommended for nonambulatory patients with GBS who present within four weeks of neuropathic symptom onset.o Therapy with plasma exchange or IVIG is suggested for ambulatory patients with GBS who present within the same timeframe, except for those who are mildly affected and already recovering.o Patients recover sooner when treated early.o The choice between plasma exchange and IVIG is dependent on local availability and on patient-related risk factors, contraindications, and preference.# Because of its ease of administration and wide availability; IVIG is frequently the preferred treatment.Guideline recommendations# Guidelines from the American Academy of Neurology IAA A) have made the following observations:o Treatment with plasma exchange or IVIG hastens recovery- from GBSo Tire beneficial effects of plasma exchange and IVIG are equivalento Combining the two treatments is not beneficialo Glucocorticoid treatment is not recommendedThe AAN recommends plasma exchange or IVIG for GBS treatment as follows :o Plasma exchange is recommendedfor nonambulatory adult patients with GBS who start treatment within four weeks of the onset of neuropathic symptoms. Plasma exchange is also recommended for ambulatory patients who start treatment within two weeks of the onset of neuropathic symptoms.o IVIG is recommended for nonambulatory> adult patients with GBS who start treatment within two or possibly four weeks of the onset of neuropathic symptoms.
Corticosteroids may be used for early recovery' and prevent long hospital stay
High dose intravenous immunoglobulin (IVIg) can be initiated
Plasmapheresis can be done
High dose intravenous immunoglobulins and plasmapharesis are equally effective
Peripheral Nerve & Muscles