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Comparison of efficacy and outcome of intravenous immunoglobulin therapy versus plasmapheresis in patients with Gullian Barre syndrome

Background Acute inflammatory demyelinating polyneuropathy (AIDP) often described as Guillain-Barre syndrome (GBS) is an ascending neuropathy involving demyelination of peripheral nerves. Very few studies on GBS have been conducted in Indian scenario in recent years. Taking into account this background, we undertook this study to have better outlook to the spectrum of disease and outcome. The objective was to study the patient’s clinical profile, outcome of the disease and response to plasmapheresis (PP) versus intravenous immunoglobulin (IVIG) therapy in a case of GBS.

Methods This was a prospective observational study. In this study 34 consecutive patients who fulfilled the inclusion and exclusion criteria and who gave a written informed consent were recruited over a period of 2 years. A detailed history and physical examination was carried out in every patient. History of preceding illnesses and clinical symptoms were recorded. End points of the study were either death during hospital stay or discharge from the hospital, whichever was early.

Results Outcome in the present study was assessed using the modified Barthel index and modified Rankin’s scale. In IVIG group both MRS and MBS showed statistically favourable outcome, at the end of study (p<0.0001). PP group showed no statistically significant improvement with either scale. Out of the 34 patients in the present study, 20.58% patients expired whereas 79.41% patients survived during the time of the study. 41.16% males expired while 30.43% females expired during the study.

Conclusions Our study showed that intravenous immunoglobulins were superior to plasmapharesis both in terms of survival and outcome in contrast to other western studies which show equal efficacy of plasmapharesis and intravenous immunoglobulins. This may indicate need for more studies to clarify this aspect especially in Asian population.