Brain Dev. 1997Jul;19(5):323-5.
Single dose immunoglobulin therapyfor childhood Guillain-Barre syndrome.
Zafeiriou DI,Kontopoulos EE, KatzosGS, Gombakis NP,Kanakoudi FG.
1st Pediatric Clinic,Aristotelian Universityof Thessaloniki, Greece.
To establish the efficacy of intravenous immunoglobulins (IVIG)in the treatment of acute Guillain-Barre syndrome (GBS), we treated nine consecutive pediatric cases (age2.5-13.5 years) fulfilling the criteria for GBS with a single dose of IVIG (Sandoglobulin;2 g/kg/BW). None of the patients experienced any IVIG related side-effects. The meantime required to improve by at least one grade on the functional GBS scale after IVIG treatment was 3.5 days, while the mean period to regain ambulation was 11.2days. Full mobilization without evidence of relapse in the follow-upper iod (mean 14.5months) was noted in all but one patient who relapsed after 5 months.We conclude that the early use of a single IVIG dose may prevent further progression of the disease, thus shortening the clinical course of childhood GBS.The most beneficial IVIG dose regimen remains to be determined by controlled trials.
Chronic inflammatorydemyelinatingpolyradiculoneuropathyin children and theirresponse to treatment.
Department of Neuropaediatrics and Muscular Disorders,Paediatric University Hospital, Freiburg,Germany.
.RESULTS: A total of 21patients (age range 2-14years) were observed clinically over a median period of four years. At the peak of the disease,12 children were unable to walk. None of the patients required artificial ventilation. Most of the children were treated with corticosteroids or high-dosage immunoglobulins (2 g/kgbody weight), or both.Nine experienced spontaneous as well as treatment-related remissions and relapses ;in twelve the degree of disability changed exclusively parallel to modifications of the
treatment.Corticosteroids were used as the first-linedrug for 11 patients and were effective foreight; prolonged treatment (up to 2years) was usually necessary.Administration of high-dosage intravenous immunoglobulins was usedf or 14 children,resulting in significant and rapid clinical improvement in 12. In eight patients the treatment with immunoglobulins had to be repeated at regular intervals for up to four years. At the last follow-up visit, 12/21patients were off treatment for 3 months to 11 years, showing none or only slight symptoms and signs; of those still receiving treatment three were ina stable condition, five exhibited significant fluctuation of symptoms, and one was unable towalk unaided. CONCLUSION: In the majority of children with CIDP, the protracted and debilitating course of the disease can be alleviated by treatment with either corticosteroids orimmunoglobulins. For patients resistant to this treatment an escalating regimen with plasmapheresis,immunosuppressive drugs or interferon-alpha should be considered.
continue to childhood CIDP