Abstract Ref Number = APCP1120
IMPROVEMENT IN GUILLAIN-BARRÉ SYNDROME DISABILITY SCALE IN GUILLAIN-BARRÉ SYNDROME PEDIATRIC PATIENT POST IVIG THERAPY
Marsha Zaneta,Ivan Riyanto Widjaja,Dicky Adi Putra,Angelina Armine S Putri
Koja General Hospital Department of Child Health, Koja General Hospital, Jakarta Indonesia General Practitioner, Koja General Hospital, Jakarta Indonesia Department of Child Health, Tanjung Priok General Hospital, Jakarta Indonesia
Background : Intravenous immunoglobulin (IVIG) is a proven effective treatment for Guillain-Barré Syndrome (GBS). The reported mortality rate of GBS following a standard IVIG dose at 1-year follow up is at 4—15%. Difficulty in diagnosing GBS and the ability to provide IVIG may affect the prognosis.
Case Presentation Summary : A 2-year-old male presented with a 3 days history of weakness of lower limbs. There was no previous history of trauma, diarrhea, respiratory tract infection, toxin exposure nor dog bite. Diagnosis of GBS (GBS Scale 4) was made based on lumbar puncture and EMG results. Referral to a tertiary hospital was made, though it was unsuccessful. Three days later, he was started on IVIG at 0.5 g/kg/day for 4 consecutive days (2 g/kg). Two months after IVIG and physical rehabilitation, he was able to sit by himself and lift his legs. On the 3 rd month, he was able to stand and walk with support (GBS Scale 3). Unfortunately, on the 4 th month he was contracted with pneumonia and died due to Acinetobacter baumanii infection in pediatric intensive care unit.
Learning Points/Discussion : The guideline for GBS IVIG therapy is a regimen of 0.4 g/kg bodyweight daily for 5 consecutive days or 1 g/kg for 2 days (total of 2 g/kg). The patient weighed 10 kg and needed 4 g/day. The available strength was 5 g in 100 ml. Aspirated contents of a vial must be used for a single infusion; therefore we modified the frequency and duration to 0.5 g/kg for 4 consecutive days (equivalent to 1 vial per day). Study shows that there is no significant difference outcome between a 5-days or 2-days regimen though the later has a higher rate of early transient relapses. IVIG cost still become an issue since it is more than 4 times higher compared to the approved GBS claim from Badan Penyelenggara Jaminan Sosial.
Keywords: Guillain-Barré Syndrome Intravenous immunoglobulin GBS immunoglobulin