YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==GUILLAIN-BARRE'S - TREATMENT== 7 AUTHOR Rees J TITLE Guillain-Barre syndrome: clinical manifestations and directions for treatment SOURCE Drugs; VOL 49 ISS Jun 1995, P912-920, (REF 41) ABSTRACT IPA COPYRIGHT: ASHP The clinical manifestations, diagnosis, treatment, and prognosis of Guillain-Barre syndrome are discussed. It was noted that specific treatment is aimed at reducing the period of maximum disability. Plasma exchange and intravenous globulin immune have been shown to be effective in randomized controlled trials. Corticosteroids alone have not been shown to be of value. The prognosis is generally good, with about 80% of patients making a full recovery. 10 AUTHOR McGhee B AUTHOR Jarjour IT TITLE Single-dose intravenous immune globulin for treatment of Guillain-Barre syndrome SOURCE Am. J. Hosp. Pharm.; VOL 51 ISS Jan 1 1994, P97-99, (REF 11) ABSTRACT IPA COPYRIGHT: ASHP The successful use of a single large dose of intravenous globulin immune (Gamimmune N) at a dose of 2 g/kg in a 3-yr-old girl with Guillain-Barre syndrome is reported. Forty-eight h after the administration of IV globulin immune, improvement in the patient's hand grip was noted and the left facial weakness was resolved. The patient continued to improve. There was no detectable weakness 6 months after IV globulin immune therapy and 7 months after the onset of Guillain-Barre syndrome. It was concluded that a single 2 g/kg dose of IV globulin immune was administered safely and appeared to aid in the recovery of a child with Guillain-Barre syndrome. 11 AUTHOR anon TITLE Double-blind trial of intravenous methylprednisolone in Guillain-Barre syndrome SOURCE Lancet; VOL 341 ISS Mar 6 1993, P586-590, (REF 26) ABSTRACT IPA COPYRIGHT: ASHP A multicenter, double-blind study evaluating the therapy of Guillain-Barre syndrome was conducted in 242 adult patients, ages 16 yr or older, 124 of whom were treated with 500 mg/day of methylprednisolone by intravenous injection for 5 days, and 118 of whom were given placebo. There was no significant difference in any outcome variable between patients given methylprednisolone and those given placebo. The 39 patients in the methylprednisolone group who required ventilation did so for a median of 18 days, 9 days fewer than the 44 ventilated patients who received placebo. Median time to walk unaided was 38 days in the methylprednisolone patients and 50 days in the placebo patients. It was concluded that a short course of high-dose methylprednisolone given early in Guillain-Barre syndrome is ineffective. 14 AUTHOR McGhee HW AUTHOR Jarjour I TITLE Response to single-dose IVIG in Guillain-Barre Syndrome (GBS) SOURCE ASHP Midyear Clinical Meeting; VOL 27 ISS Dec 1992, PP-631D, (REF ) ABSTRACT IPA COPYRIGHT: ASHP This case describes the apparent effectiveness of single large dose therapy with IVIG in GBS. Four-hundred milligrams per kilogram per day of IVIG for 5 days is considered to be the safe and effective treatment for GBS. At our institution, a 2 gram per kilogram dose of IVIG was inadvertently prescribed and administered over a 12-hour period to a 3-year-old patient with GBS. Within 4 weeks the patient was able to walk with assistance. At 2 months, only mild weakness remained in the knee and ankle flexion. Single doses of IVIG in GBS may be effective for three reasons: 1) success with two-day regimens; 2) the attainment of comparable effective serum levels; and 3) other inflammatory conditions are now treated with single-dose therapy. Perhaps, large single doses of IVIG may be effective for GBS. 17 AUTHOR Urtasun M AUTHOR Lopez De Munain A AUTHOR Carrera N AUTHOR Marti-Masso JF AUTHOR Mozo C AUTHOR et al TITLE High-dose intravenous immune globulin in the management of severe Guillain-Barre syndrome SOURCE Ann. Pharmacother.; VOL 26 ISS Jan 1992, P32-33, (REF 11) ABSTRACT IPA COPYRIGHT: ASHP A retrospective study was conducted to compare the efficacy and costs of high dose intravenous globulin immune (gammaglobulin) with those of plasmapheresis in 6 patients (ages 20-64 yr) with Guillain-Barre syndrome (GBS), 4 of whom were treated with plasmapheresis and 2 with 0.4 g/kg/day globulin immune for 5 days. Clinical recovery appeared to be faster and more complete in the globulin immune group than in the plasmapheresis group. No adverse reactions were reported in the globulin immune group. Total costs per day were $1500.80 in the plasmapheresis group and $1417.17 in the globulin immune group. It was concluded that immune globulin may be more effective and less expensive than plasmapheresis in patients with GBS. 18 AUTHOR Van Der Meche FG AUTHOR Schmitz PI AUTHOR et al TITLE Randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barre syndrome SOURCE N. Engl. J. Med.; VOL 326 ISS Apr 23 1992, P1123-1129, (REF 35) ABSTRACT IPA COPYRIGHT: ASHP To determine if intravenous (IV) immune globulin (Gammagard) is as effective as the more complicated treatment with plasma exchange in patients with the Guillain-Barre syndrome, the Dutch Guillain-Barre Study Group conducted a multicenter, randomized trial in 147 patients with the syndrome who received either 5 plasma exchanges of 200 to 250 ml/kg or 5 doses of 0.4 g/kg/day of an IV immune globulin preparation. Strength was improved by one grade or more in 34% of those treated with plasma exchange, as compared with 53% of those treated with immune globulin. The median time to improvement by one grade was 41 days with plasma exchange and 27 days with immune globulin therapy. The immune globulin group had significantly fewer complications and less need for artificial ventilation. It was concluded that in the acute Guillain-Barre syndrome, treatment with IV immune globulin is at least as effective as plasma exchange and may be superior.