GBS

Q: All of the following have a role in the management of Guillain-Barré syndrome (GBS) except? 

 A) plasma exchange (PE) (plasmapheresis) 
 B) intravenous immune globulin (IVIG) 
C) glucocorticoids 
D) erythromycin 
 E) gabapentin


Answer: C

Steroids have been tried in GBS in the hope that due to their anti-inflammatory role they will be helpful, but they failed to show any promising effect. Instead, they can be harmful if continued for prolong duration with myopathy and other related side effects, including infections etc. None of the studies or meta-analyses spread over 25 years were able to show any benefit, and the issue seems settled for the role of glucocorticoids in GBS. 

PE and IVIG remained as a mainstay of treatment as disease-modifying modalities. Erythromycin helps in bowel dysfunction and gabapentin is very effective in relieving neural pain.

#neurology


References:

1.  Hughes RA. Ineffectiveness of high-dose intravenous methylprednisolone in Guillain-Barré syndrome. Lancet 1991; 338:1142.

2. Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Guillain-Barré Syndrome Steroid Trial Group. Lancet 1993; 341:586. 

3. Hughes RA, Brassington R, Gunn AA, van Doorn PA. Corticosteroids for Guillain-Barré syndrome. Cochrane Database Syst Rev 2016; 10:CD001446.