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Guillain-Barr syndrome is a disorder in which the body’s immune system attacks part of the peripheral nervous system. Symptoms include varying degrees of weakness or tingling sensations in the legs. Sometimes, the weakness and abnormal sensations spread to the arms and upper body and progress to paralysis. There is no known cure for Guillain-Barr syndrome, but therapies can lessen the severity of the illness and accelerate the recovery in most patients. Currently, plasmapheresis and high-dose immunoglobulin therapy are most often used.

Both plasma exchange (PE) therapy and intravenous immune globulin (IVIG) have proven effective for Guillain-Barr syndrome (GBS). They are both thought to diminish autoantibody production and increase solubilization and removal of immune complexes. Both have been shown to shorten recovery time by as much as 50%. IVIG is easier to administer and has fewer complications than PE and is usually the initial treatment.

Randomized trials in severe disease show that IVIG started within 4 weeks from onset hastens recovery as much as plasma exchange. Combination therapy of both, does not improve outcomes or shortened illness duration over one or the other.

1. Shahar E. Current therapeutic options in severe Guillain-Barre syndrome. Neuropharmacol. Jan-Feb 2006;29(1):45-51

2.Bascic-Kes V, Kes P, Zavoreo I, Lisak M, Zadro L, Coric L, et al. Guidelines for the use of intravenous immunoglobulin in the treatment of neurologic diseases. Acta Clin Croat. Dec 2012;51(4):673-83.

3.[Best Evidence] Hughes RA, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barr syndrome. Cochrane Database Syst Rev. Jun 16 2010;6:CD002063

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For Rituxan for Gullain-barre see here