Treatment of Guillain-Barré syndrome: drugs and supportive therapy

Immunotherapy

Immunotherapy includes plasmapheresis and administration of immunoglobulins (IVIg). It is one of the effective treatment methods.

Immunotherapy is used in cases where the patient is unable to walk at least 10 metres without assistance.

The combination of the two methods mentioned above has so far not produced better results than choosing either method alone. Both of these treatments are approximately the same cost and both share the common principle of reducing the time required for recovery.

IVIg is most effective if treatment is started within two weeks of the onset of gait disturbance. IVIg preparations vary depending on the manufacturer, and have different salt, sugar, pH and IgA antibody contents.

IVIg treatment must be strictly individual and tailored to the specific patient.

The main active component of IVIG is IgG antibodies. These antibodies occupy receptors on damaged nerve structures, thereby preventing the binding of "harmful" autoantibodies.

The usual dose of IVIG is 2 g of the drug per 1 kg of patient weight. The dose is divided over a period of two to five days.

During the first hour of infusion, continuous monitoring of the patient's vital signs every 15 minutes is important. Paracetamol or an antihistamine may be given before each dose.

The treatment is more demanding on the kidneys. Therefore, kidney function should be checked before and regularly after each dose. People with impaired kidney function should have half the normal infusion rate.

Serious adverse side effects include:

• venous thromboembolism (formation of a clot in a vein with a pathway to the body).
• anaphylaxis (severe allergic reaction that is life-threatening)
• acute renal failure
• aseptic meningitis
• stroke-like conditions

However, patients receiving IVIG treatment still have fewer treatment-related side effects and complications than patients set up for plasmapheresis.

Plasmapheresis is a treatment method in which autoantibodies are removed from the blood. It is contraindicated in pregnant patients or hemodynamically unstable patients.

Plasmapheresis is administered within 4 weeks of symptom onset in non-ambulatory patients and within 2 weeks in ambulatory patients.

The most common adverse effects include hypotension, hypocalcemia, and thrombocytopenia, which usually improve within 24-48 hours.

If patients must undergo multiple plasma exchanges, individual sessions should be spaced 24 hours apart to prevent a drop in clotting factors.

The benefits of plasmapheresis treatment include restoration of muscle strength, a lower likelihood of permanent motor disability, and fewer relapses 1 year after the first episode of GBS.

Corticotherapy

Corticosteroids are not beneficial in the treatment of GBS and may even worsen the patient's condition.

Supportive therapy

Supportive therapy is essential in the treatment of GBS. Prevention of deep vein thrombosis is essential. Heparin preparations, enoxaparin are given.

Putting on elastic compression stockings until the patient is able to walk independently is also effective.

Monitoring breathing, pulse and blood pressure is a very important part of the treatment of a patient with GBS.

In patients who need to be ventilated with artificial lung ventilation, a tracheostomy (removal of the tube for long-term ventilation) should be performed after 2 weeks.

Simple analgesics such as paracetamol and non-steroidal anti-inflammatory drugs are also given, but these may not be effective against muscle pain.

Opioid analgesics are usually chosen for pain relief. Their administration is associated with a number of side effects such as defecation, constipation, bladder disturbances and others.

Rehabilitation therapy should focus on proper limb positioning, posture and maintaining proper nutrition.

Vaccinations should be omitted in the acute phase or 1 year after an episode of GBS. After that, active immunization can be performed. Exceptions are vaccines that have a risk of GBS in the post-vaccination period.