A 25-year-old woman presents with progressive ascending weakness, areflexia, and CSF showing albumino-cytologic dissociation. Nerve conduction studies show prolonged distal latencies and absent F-waves. She is intubated due to declining forced vital capacity. The choice between IV immunoglobulin and plasma exchange in GBS is based on the following evidence:

• A Plasma exchange is superior in all GBS subtypes
• B IVIG is preferred only in children; plasma exchange preferred in adults
• C Combination of IVIG plus plasma exchange is the standard of care
• D IVIG (2 g/kg over 5 days) and plasma exchange (5 sessions) are equally effective; combination is not better than either alone ✓

Explanation

The Dutch GBS study group (1997) and subsequent Cochrane reviews established that IVIG (2 g/kg over 2–5 days) and plasma exchange (5 exchanges over 2 weeks) have equivalent efficacy in GBS regarding disability grade improvement, time to walking, and recovery. Crucially, the combination of both treatments in a sequential fashion was NOT superior to either treatment alone in a randomized trial. Corticosteroids are not beneficial in GBS. Both treatments are administered in severe GBS (unable to walk unassisted), and the choice is often based on availability, contraindications, and patient factors.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.