Comparing the Therapeutic Modalities of Guillain–Barré Syndrome: Therapeutic Plasma Exchange versus Intravenous Immunoglobulin

Guillain–Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide, with an annual global incidence of approximately 1–2 per 100,000 person-year. Specific treatment of the patients comprises intravenous immunoglobulin (IVIG) or plasma exchange (PE). Majority of studies comparing either modalities of treatment has been conducted in developed countries with better Hospital infrastructure and mechanical ventilation facilities. Therefore it’s necessary to elicit the outcome of GBS in resource poor settings like ours. Moreover most of the studies comparing either modalities of therapy, have been done retrospectively. Further, studies evaluating functional neurological outcomes after IVIG or PE are lacking. Therefore with this study we aim to compare PE and IVIG as a first line treatment for patients with GBS in our setup in terms of neurological outcomes of the affected patients.

 This is a randomized parallel group trial consisting of 45 patients in each arm selected by convenient sampling and randomized via computerized random number generator, where adult patients of either sex with clinical and electrophysiological diagnosis of GBS will be included. Patients with comorbidities, those with clinical plateau of disease and those where either of the therapeutic modalities are contraindicated, will be excluded from the study. Therapy with either IVIG or PE will be started after randomization and patient will be evaluated as per GBS disability score throughout the treatment period at day 0,7,14, 28 and at 6 months. A decrease in GBS Disability scale by 1 or more points at discharge as compared to the same at admission will be considered as the outcome measure.