"The bottom line here is that IVIg, or immunoglobulin infusion, is the preferred treatment for Guillain-Barr, depending on availability," says Eelco Wijdicks, M.D., a Mayo Clinic neurologist and second author of the paper. Availability of IVIg treatment is compromised at times by shortages of gamma globulin, Dr. Wijdicks notes.
Although both this treatment and the other major immunotherapy for Guillain-Barr Syndrome, plasma exchange, hasten recovery and are equally effective, IVIg is preferable to plasma exchange, according to the new recommendations. IVIg involves intravenously administering large dosages of normal antibodies from donated blood. Plasma exchange involves removing the plasma from a patient's blood, isolating it from the blood cells, replacing it with albumin, another blood product, and then putting the cells back into the body.
"There is no question that plasma exchange could have more complications," says Dr. Wijdicks. "Hypotension -- low blood pressure -- is possible. Catheter placement in large veins has a tendency to cause more complications. IVIg is easier to use and there are fewer complications. With evidence of comparable effect, it should be the treatment of choice."
Dr. Wijdicks also explains that in comparison with infusion plasma exchange is much more complicated logistically, and requires a specialized, experienced plasma exchange team.
Early treatment is key to the effectiveness of immunotherapy treatments, according to the expert panel that formed the Gu
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