Guillain-Barré Sendromu Tedavisi
Özet
Guillain-Barré sendromu (GBS), akut başlangıçlı, immün aracılı bir poliradikülonöropatidir. Edinsel nöromüsküler paralizinin en sık nedenlerindendir. Klinik olarak genellikle alt ekstremitelerde başlayan ve asendan seyir gösteren progresif güçsüzlük, arefleksi ve beyin omurilik sıvısında albuminositolojik disosiasyon ile karakterizedir. Hastalık şiddetinin doğru değerlendirilmesi, uygun tedavi seçiminin temelini oluşturur. Bu amaçla Guillain-Barré Özürlülük Skoru sıklıkla kullanılmaktadır. Günümüzde GBS tedavisinde etkinliği kanıtlanmış iki temel yöntem bulunmaktadır: plazma değişimi ve intravenöz immünglobulin (IVIg). Her iki tedavi seçeneğinin de hastalık süresini kısalttığı, iyileşmeyi hızlandırdığı ve komplikasyon riskini azalttığı gösterilmiştir. Klinik çalışmalar ve güncel kılavuzlar, özellikle mobiliteyi bozan güçsüzlüğü olan veya hızlı kötüleşme riski taşıyan hastalarda tedavinin erken dönemde başlanmasını önermektedir. Hafif klinik seyirli ve stabil olgularda ise medikal tedavi genellikle gerekli değildir. Plazma değişimi ile IVIg arasında etkinlik açısından belirgin bir üstünlük saptanmamış olup, tedavi seçimi hastanın klinik durumu, eşlik eden hastalıkları ve uygulama koşullarına göre yapılmalıdır. Kortikosteroidlerin ve diğer immünmodülatör ajanların etkinliği gösterilememiştir. Destek tedavileri, ağrı yönetimi, erken rehabilitasyon ve psikososyal destek GBS yönetiminin ayrılmaz parçalarıdır.
Referanslar
Bellanti R, Rinaldi S. Guillain-Barré syndrome: a comprehensive review. Eur J Neurol. 2024 Aug;31(8):e16365. doi: 10.1111/ene.16365.
Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology. 2011;36(2):123-33. doi: 10.1159/000324710.
Doets AY, Verboon C, van den Berg B; IGOS Consortium. Regional variation of Guillain-Barré syndrome. Brain. 2018 Oct 1;141(10):2866-2877. doi: 10.1093/brain/awy232
Rajabally YA, Uncini A. Outcome and its predictors in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2012 Jul;83(7):711-8. doi: 10.1136/jnnp-2011-301882. Epub 2012 May 7. PMID: 22566597.
Leonhard SE, Mandarakas MR, Gondim FAA. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Nov;15(11):671-683. doi: 10.1038/s41582-019-0250-9.
Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 Suppl:S21-4. doi: 10.1002/ana.410270707.
Wijdicks EF, Klein CJ. Guillain-Barré Syndrome. Mayo Clin Proc. 2017 Mar;92(3):467-479. doi: 10.1016/j.mayocp.2016.12.002.
van den Berg B, Bunschoten C, van Doorn PA, Jacobs BC. Mortality in Guillain-Barre syndrome. Neurology. 2013 Apr 30;80(18):1650-4. doi: 10.1212/WNL.0b013e3182904fcc.
van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992 Apr 23;326(17):1123-9. doi: 10.1056/NEJM199204233261705.
Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978 Oct 7;2(8093):750-3. doi: 10.1016/s0140-6736(78)92644-2.
Wijdicks EF. Guillain-Barré Syndrome. Neurocrit Care. 2016 Oct;25(2):288-92. doi: 10.1007/s12028-016-0323-1.
Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017 Feb 27;2(2):CD001798. doi: 10.1002/14651858.CD001798.pub3.
van Doorn PA, Van den Bergh PYK, Hadden RDM European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol. 2023 Dec;30(12):3646-3674. doi: 10.1111/ene.16073.
Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome. Ann Neurol. 1987 Dec;22(6):753-61. doi: 10.1002/ana.410220612.
Korinthenberg R, Schessl J, Kirschner J, Intravenously administered immunoglobulin in the treatment of childhood Guillain-Barré syndrome: a randomized trial. Pediatrics. 2005 Jul;116(1):8-14. doi: 10.1542/peds.2004-1324
Walgaard C, Jacobs BC, Lingsma HF, Dutch GBS Study Group. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2021 Apr;20(4):275-283. doi: 10.1016/S1474-4422(20)30494-4.
Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2014 Sep 19;2014(9):CD002063. doi: 10.1002/14651858.CD002063.pub6.
Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Lancet. 1997 Jan 25;349(9047):225-30.
Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Guillain-Barré Syndrome Steroid Trial Group. Lancet. 1993 Mar 6;341(8845):586-90.
van Koningsveld R, Schmitz PI, Meché FG; Dutch GBS study group. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet. 2004 Jan 17;363(9404):192-6. doi: 10.1016/s0140-6736(03)15324-x.
Halstead SK, Zitman FM, Humphreys PD; Eculizumab prevents anti-ganglioside antibody-mediated neuropathy in a murine model. Brain. 2008 May;131(Pt 5):1197-208. doi: 10.1093/brain/awm316.
Misawa S, Kuwabara S, Sato Y; Japanese Eculizumab Trial for GBS (JET-GBS) Study Group. Safety and efficacy of eculizumab in Guillain-Barré syndrome: a multicentre, double-blind, randomised phase 2 trial. Lancet Neurol. 2018 Jun;17(6):519-529. doi: 10.1016/S1474-4422(18)30114-5.
Tzachanis D, Hamdan A, Uhlmann EJ; Successful treatment of refractory Guillain-Barre syndrome with alemtuzumab in a patient with chronic lymphocytic leukemia. Acta Haematol. 2014; 132: 240-243.
Bensa S, Hadden RD, Hahn A; Randomized controlled trial of brain-derived neurotrophic factor in Guillain-Barre syndrome: a pilot study. Eur J Neurol. 2000; 7: 423-426.
Wollinsky KH, Hulser PJ, Brinkmeier H; CSF filtration is an effective treatment of Guillain-Barre syndrome: a randomized clinical trial. Neurology. 2001; 57: 774-780.
Ahuja GK, Mohandas S, Virmani V; Cyclophosphamide in Landry-Guillain-Barre Syndrome. Acta Neurol. 1980; 2: 186-190.
Pritchard J, Gray IA, Idrissova ZR; A randomized controlled trial of recombinant interferon-beta 1a in Guillain-Barre syndrome. Neurology. 2003; 61: 1282-1284.
Garssen MP, van Koningsveld R, van Doorn PA; Treatment of Guillain-Barre syndrome with mycophenolate mofetil: a pilot study. J Neurol Neurosurg Psychiatry. 2007; 78: 1012-1013.
Sprenger-Svačina A, Svačina MKR, Gao T; Emerging treatment landscape for Guillain-Barré Syndrome (GBS): what's new? Expert Opin Investig Drugs. 2024 Sep;33(9):881-886. doi: 10.1080/13543784.2024.2377323.
Harbo T, Markvardsen LK, Hellfritzsch MB; Neuromuscular electrical stimulation in early rehabilitation of Guillain-Barre syndrome: a pilot study. Muscle Nerve. 2019; 59: 481-484.
Sendhilkumar R, Gupta A, Nagarathna R; Effect of pranayama and meditation as an add-on therapy in rehabilitation of patients with Guillain-Barre syndrome—a randomized control pilot study. Disabil Rehabil. 2013; 35: 57-62.
Liu J, Wang LN, McNicol ED. Pharmacological treatment for pain in Guillain-Barre syndrome. Cochrane Database Syst Rev. 2015; 4:CD009950.
