Use of immunoglobulin in severe childhood Guillain-Barre´ syndrome Introduction Intravenous immunoglobulin (IVIg) is one of the elective treatments in Guillain-Barre´ syndrome (GBS) and has less complications than those associated with plasmapheresis (1, 2). In many cases, plasmapheresis in children with GBS shor- tens the time to recover independent walking activity (3). The comparison between IVIg and plasmapheresis in children with GBS has been performed in a reduced number of patients and the conclusions should be analyzed with caution (4). The use of IVIg in special groups, as in the case of children, has many contradictory recommenda- tions and causes strong controversies (5). It has been suggested that IVIg treatment should be used in mild cases, in order to avoid spreading of the symptoms but on the other hand, it is considered that the treatment of IVIg in children should only be administered in severe cases because of rather weak evidence to support its benefit. Publications showing the benefits of the use of IVIg in the disease have only a small number of patients or are based on historical controls (6, 7). In other studies, the benefits of IVIg treatment are rather poor in critical cases (8). One of the expected results of the application of IVIg should be less number of days of ventilatory support in patients admitted to the intensive care unit (ICU). Studies of predicting the medical risks associated with the length of time of ventilatory support, and the benefits of the use of IVIg treatment in diminish- ing the days of admission to the ICU are scarce. Ventilatory support is for a longer period in older patients or in those with an underlying lung illness (9). Studies with a small number of mechanically ventilated children, IVIg treatment shows reduc- tion in the number of days of ventilatory support and the number of days of hospitalization in the ICU (10). Acta Neurol Scand 2007: 115: 289–293 DOI: 10.1111/j.1600-0404.2006.00766.x Copyright Ó 2007 The Authors Journal compilation Ó 2007 Blackwell Munksgaard ACTA NEUROLOGICA SCANDINAVICA Ortiz-Corredor F, Pen˜a-Preciado M. Use of immunoglobulin in severe childhood Guillain-Barre´ syndrome. Acta Neurol Scand 2007: 115: 289–293. Ó 2007 The Authors Journal compilation Ó 2007 Blackwell Munksgaard. Objectives – To compare the clinical results in children with Guillain– Barre´ syndrome (GBS) admitted to the intensive care unit. Patients treated with intravenous immunoglobulin (IVIg) were compared with patients admitted before the immunoglobulin treatment was introduced. Design – Study of historical cohorts. Methods – The outcome of the children who did not receive IVIg before 1993 was compared with those children who received immunoglobulin treatment from this year until 2002. The days of ventilatory support and the time it took to reach state III on the GBS disability scale were used as measures of outcome. Age, muscular strength, cranial nerve palsy and the electrophysiological classification were the independent variables. Results – In all, 48 of 96 children were classified – 18 patients as axonal motor acute neuropathy (AMAN) and 30 patients as axonal inflammatory demyelinating polyneuropathy (AIDP). For both groups the analysis showed similar results behavior when comparing the outcome of patients with or without immunoglobulin treatment. A high proportion of patients with unexcitable nerves was found in the group with immunoglobulin treatment. Quadriplegia and the presence of unexcitable motor nerves were associated with a longer period of recovery. Conclusion – Immunoglobulin did not change the history of the illness as far as the time of ventilatory support in AMAN and AIDP groups is concerned and the time to reach state III on the GBS disability scale. F. Ortiz-Corredor 1,2 , M. PeÇa- Preciado 3 1 Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia, 2 Instituto de Ortopedia Infantil Roosevelt and 3 Department of Neurology, Universidad Nacional de Colombia, Bogota´, Colombia Key words: Guillain-BarrØ syndrome; intravenous immunoglobulin; children; prognosis; mechanical ventilation Fernando Ortiz-Corredor, Department of Physical Medi- cine and Rehabilitation, Universidad Nacional de Colombia and Instituto de Ortopedia Infantil Roosevelt, Bogota´, Colombia Tel: 316 5000 (ext. 15076) e-mail: fortizc@unal.edu.co Accepted for publication October 3, 2006 289