The Evidence-Based Practive for the Effectiveness of IVIG on Neurological Symptoms in Patients who have GBS

DeMello II, Dominic, and Joyce Conley

Guillain-barre syndrome (GBS) is an autoimmune disorder which normally presents with transient peripheral limb paralysis. Two main treatments recommended by the American Academy of Neurology, Plasmapheresis (PE), which is recommended as Level A and has proven effective, and Intravenous Immunoglobulin (IVIg), which has been rated Level B, probably useful or effective. (National Guideline Clearinghouse, 2009) The intention of this literature review is to consider the effectiveness of IVIg on neurological symptoms in patients who have GBS. IVIg is not considered the main standard of care; nevertheless it is more cost effective and less invasive than PE, which has been proven effective.

The literature search for evidence based sources was conducted using the PubMed and Cochrane library search engines. The initial search criteria utilized was Guillain-Barre Syndrome. The results were further narrowed using the following criteria: Immunoglobulin, IVIg, English language only, human subjects only, and no articles before 1- 1- 2004. Only 30 articles were available in full text. Articles that pertained to the use or effectiveness of immunoglobulin in the treatment of GBS were included. One article was included from beyond the past 5 year deadline because it addressed the possible relapse in GBS after being treated with IVIg. An article addressing the relapse issue that reflects on the effectiveness of IVIg as a treatment method was not able to be found within the past 5 years.

It was determined that IVIg was as effective as PE, and that it presented with less adverse reactions as proven by the Hughes (2007) study, and the Faranca Jr. (2005). Less relapses were noted with IVIg than PE, per the study conducted by Romano (1998). Clinical practice implications include method of treatment, speed of diagnosis, ease and cost of treatment.