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 Volume 61, Number 6, September 23, 2003
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Neurology 2003;61:736-740
© 2003 American Academy of Neurology
Special Article

Practice parameter: Immunotherapy for Guillain–Barré syndrome

Report of the Quality Standards Subcommittee of the American Academy of Neurology R.A.C. Hughes, MD, E.F.M. Wijdicks, MD, R. Barohn, MD, E. Benson, D.R. Cornblath, MD, A. F. Hahn, MD, J.M. Meythaler, MD, R.G. Miller, MD, J.T. Sladky, MD and J.C. Stevens, MD

From the Department of Neuroimmunology (Dr. Hughes), Guy’s, King’s and St. Thomas’ School of Medicine, London, UK; Department of Neurology (Dr. Wijdicks), Mayo Clinic, Rochester, MN; Department of Neurology (Dr. Barohn), University of Kansas Medical Center, Kansas City, KS; Guillain–Barré Syndrome Foundation International (E. Benson), Wynnewood, PA; London Health Sciences Center (Dr. Hahn), London, Canada; Department of Neurology (Dr. Cornblath), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation (Dr. Meythaler), The University of Alabama, Birmingham, AL; Department of Neurology (Dr. Miller), California Pacific Medical Center, San Francisco, CA; Division of Neurology (Dr. Sladky), Emory University School of Medicine, Atlanta, GA; and Fort Wayne Neurological Center (Dr. Stevens), Fort Wayne, IN.

Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

Objective: To provide an evidence-based statement to guide physicians in the management of Guillain–Barré syndrome (GBS).

Methods: Literature search and derivation of evidence-based statements concerning the use of immunotherapy were performed.

Results: Treatment with plasma exchange (PE) or IV immunoglobulin (IVIg) hastens recovery from GBS. Combining the two treatments is not beneficial. Steroid treatment given alone is not beneficial. Recommendations: 1) PE is recommended for nonambulant adult patients with GBS who seek treatment within 4 weeks of the onset of neuropathic symptoms. PE should also be considered for ambulant patients examined within 2 weeks of the onset of neuropathic symptoms; 2) IVIg is recommended for nonambulant adult patients with GBS within 2 or possibly 4 weeks of the onset of neuropathic symptoms. The effects of PE and IVIg are equivalent; 3) Corticosteroids are not recommended for the management of GBS; 4) Sequential treatment with PE followed by IVIg, or immunoabsorption followed by IVIg is not recommended for patients with GBS; and 5) PE and IVIg are treatment options for children with severe GBS.




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Correspondence:

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Practice parameter: Immunotherapy for Guillain–Barré syndrome: Report of the Quality Standards Subco
Norman Latov
Neurology Online, 19 Nov 2003 [Full text]
Reply to Latov
Richard AC Hughes
Neurology Online, 19 Nov 2003 [Full text]