Even though studies have shown that no benefits of using corticosteroids alone, there is evidence through a Dutch study which compared intravenous methyl prednisolone with IVIg maybe beneficial when compared with IVIg alone (Hughes, R. A. C. , 2002). Plasma exchange was the first treatment known to be proven beneficial in the case of GBS patients. However, studies have shown no added benefit from combining plasma exchange treatment with intravenous immunoglobin. Studies have also noted that patients who undergo plasma exchanges are more frequently seen with complications such as cardiac arrhythmias (Hughes, R.A. C. , 2002).
The drawback to the plasma exchange is that it requires maintenance of a central line. This can lead to future risks of development of hematoma or pneumothorax. It also increases the risk of a septicemia. Multiple plasma exchange can lead to a potential coagultopathic state and this can lead to the patients needing clotting factor and fibrinogen transfusions. IVIg according to a Dutch trail is a slightly more superior treatment option when compared with PE. This study compared 4 trials on 495 patients.
It also found no significant differences when comparing IVIg alone with IVIg and PE, in reducing the disability grade of GBS patients (Hughes, R. A. C. , 2002). IVIg is easier to administer in patents when compared with PE. Therefore most often, it is the choice of treatment in many hospitals. There is no evidence to support the theory that IVIg may also help hasten the recovery in patients who come for treatment 2 weeks after the symptoms have started. (Hughes, R. A. C. , 2002). IVIg is linked to its own set of adverse effects. The less severe effects include joint pains, muscle pains and headaches.
A more serious effect can occur in the form of transient hypercoagulobilty state. During IVIg treatment, patients must be monitored for this condition as this can lead to an increased risk of thrombosis. Increase in volume can lead to pulmonary edema. IgA deficient patients are at risk for potentially more serious complications including kidney failure, aseptic meningitis and hepatitis. Conclusion Even through PE and IVIg are commonly used as a mainstay for treatment, sufficient dats is not present on the other treatment options including use of interferons, cytotoxic drugs, CSF filtration techniques etc.
inadequate data is available to weigh the side effects of the use of these treatment options. Further research to explore the adverse effects the available treatments need to be undertaken. Not much data is available on patients who come for treatment more than 2 weeks after symptoms appear. Trials with large sample sizes need to be conducted in this area in the future to reduce long term disability and so that the patients proper patient treatment and care.
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