A 15-year old boy presents with weakness in both lower limbs that has progressed to involve the trunk over the last 6 days. Examination shows reduced power in muscles of the lower limbs, abdomen and chest; deep tendon reflexes are absent. CSF examination shows no cells, sugar-80 mg/dl and protein 80 mg/dl. The treatment of choice is:
The boy is suffering from Guillain-Barre syndrome, which is a postinfectious polyneuropathy that causes demyelination in mainly motor but sometimes also sensory nerves. The main clues for diagnosis are areflexic paralysis with alburnino-cytologic dissociation in CSF. The paralysis usually follows a nonspecific viral infection by about 10 days. Weakness begins usually in the lower extremities and progressively involves the trunk, the upper limbs, and finally the bulbar muscles, a pattern formerly known as Landry ascending paralysis. Tendon reflexes are lost, usually early in the course. Rapidly progressive ascending paralysis is treated with intravenous immunoglobulin (IVIg), administered for 2, 3, or 5 days. Plasmapheresis, steroids, and/or immunosuppressive drugs are alternatives, if IVlg is ineffective. Suppoive care, such as respiratory suppo, prevention of decubitus ulcerin children with flaccid tetraplegia, and treatment of secondary bacterial infections, is impoant.
I/V methylprednisolone
I/V immunoglobulin
I/V anti-thymocyte globulin
Oral cycIosporin and prednisolone