INTRAVENOUS IMMUNOGLOBULIN PER SE OR COMBINED WITH INTRAVENOUS METHYLPREDNISOLONE IN CHILDREN WITH GBS; COMPARING THE EFFECTS

Objective Guillain-Barre syndrome (GBS) is the most common cause of acute neuromuscular paralysis in children, its pathogenesis most probably involving an autoimmune response to Schwann cell or peripheral nerve myelin antigens. Steroid regimes improve demyelinating diseases such as chronic GBS. We assessed the benefit of high dose methylprednisolone (MP) combined with Intravenous immunoglobulin (MP-IVIG) and compared the effects with those of IVIG per se in children with GBS. Materials& Methods Thirty-six children, aged between 1-12 years were randomized to receive IV MP 20mg/kg/day combined with IVIG 400 mg/kg/day (MP-IVIG) or IVIG per se at same dose for 5 days. All patients were diagnosed by standard clinical criteria and entered the trial within less than 2 weeks of the onset of neurological symptoms. All patients were too weak to walk. Functional grade (FG) was at 3 or more (able to walk with support). Results In the MP-IVIG group, FG improved at least one grade after 5 days of treatment (P < 0.05), while those who received only IVIG had no significant improvement in their FGs after 5 days of treatment (P < 0.2). The main outcome result remained significantly in favor of the MP-IVIG treatment group. There was no significant difference in improvement of one or more FG between the groups, after 4 weeks of treatment (secondary outcome). The median time required to improve one FG was 12 days in MP-IVIG as compared with 21 days in IVIG per se (P < 0.5), and the median time required to reach the stage of walking independently (FG=2) was 36 days in MP-IVIG as compared to 43 days in IVIG per se (P < 0.03). Conclusion This study suggests that combined treatment with MP-IVIG in children with GBS does cause rapid improvement in the acute phase, but does not result in any significant difference in the long term outcome.