Guillain–Barre syndrome: small-volume plasmapheresis versus intravenous immunoglobulin—3rd level hospital experience

Abstract

Specific treatment for Guillain–Barre syndrome is based on plasma exchange and intravenous immunoglobulin (IvIg). In developing countries such as Morocco, we are often confronted with constraints in terms of price and availability of substitutes. Comparative studies of these two therapeutic modalities have been conducted particularly in severely extensive forms. Our study compared small-volume plasmapheresis (SVP) with intravenous Immunoglobulin over a nine-year period in the neurology department of the University Hospital Center of Marrakech in terms of efficacy and safety in Moroccan patients with GBS of varying degrees of severity. We included 76 patients who were hospitalized for GBS. Forty-six patients were treated with SVP and 30 were treated with IvIg. The therapeutic choice depended on contraindications, socioeconomic considerations, patient choice, and availability of treatment. The clinical and paraclinical evaluations of the two groups were statistically comparable, including factors that may influence the prognosis (p > 0.05). The efficacy of IvIg and SVP did not show a statistically significant difference except for a longer neurology department stay with plasmapheresis (p < 0.001). This efficacy is evaluated by the evolution of the Hughes and MRC sum scores one month after treatment, length of hospital stay, use of mechanical ventilation and its duration, and mortality rate. The results selected further encourage the use of SVP because of its efficacy and safety, which are comparable to those of IvIg. And the review of the literature confirms our recommendations.