How is Guillain-Barré treated?

There is no known cure for Guillain-Barré syndrome. However, there are therapies that lessen the severity of the condition and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease.

Currently, plasma exchange (also called plasmapheresis) and high-dose immunoglobulin therapy are used. Both of them are equally effective, but immunoglobulin is easier to administer. Plasma exchange is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still don't know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barré episode. This may be because plasmapheresis can remove antibodies and other immune cell-derived factors that could contribute to nerve damage.

In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that the immune system uses naturally to attack invading organisms. Investigators have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to Guillain-Barré patients can lessen the immune attack on the nervous system. Investigators don't know why or how this works, although several hypotheses have been proposed.

The use of steroid hormones has also been tried as a way to reduce the severity of Guillain-Barré, but controlled clinical trials have demonstrated that this treatment is not effective and may even have a deleterious effect on the disease.

The most critical part of the treatment for this syndrome consists of keeping the patient's body functioning during recovery of the nervous system. This can sometimes require placing the patient on mechanical ventilatory assistance, a heart monitor, or other machines that assist body function. The need for this sophisticated machinery is one reason why Guillain-Barré syndrome patients are usually treated in hospitals, often in an intensive care ward. In the hospital, doctors can also look for and treat the many problems that can afflict any paralysed patient - complications such as pneumonia or bed sores. 

Physical therapy should commence immediately once the diagnosis is made. (Kindly refer to the next article, which deals with GB and Physiotherapy and the role physiotherapists can play.)

Carefully planned clinical trials of new and experimental therapies are the key to improving the treatment of patients with Guillain-Barré syndrome. Such clinical trials begin with the research of basic and clinical scientists who, working with clinicians, identify new approaches to treating patients with the syndrome.

Caregivers can play a vital role in assisting the recovery of these patients. Careful instructions should be given and monitored to the caregivers and family by the physiotherapist. Manual movement of the patient's limbs is important to help keep the muscles flexible and strong and to prevent a possible build-up of red blood cells in veins, which could lead to reduced blood flow in the limbs (which could result in deep vein thrombosis).

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