Imunoterapia na Síndrome de Guillain-Barré Pediátrica: Imunoglobulina Endovenosa, Plasmaferese, Ambas ou Algo Mais?

Autores

  • Gonçalo Favinha University of Coimbra, Faculty of Medicine, Coimbra, Portugal
  • Joana Amaral Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Catarina Gomes University of Coimbra, Faculty of Medicine, Coimbra, Portugal
  • Filipe Palavra Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University of Coimbra, Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal https://orcid.org/0000-0002-2165-130X

DOI:

https://doi.org/10.46531/sinapse/AR/220002/2022

Palavras-chave:

Criança, Imunoglobulina Intravenosa, Imunoterapia, Plasmaferese, Síndrome de Guillain-Barré/ tratamento, Troca Plasmática

Resumo

A síndrome de Guillain-Barré (SGB) é uma doença autoimune do sistema nervoso periférico que se caracteriza clinicamente por fraqueza muscular simétrica e de rápida progressão, perda (ou atenuação) dos reflexos miotáticos e dificuldade respiratória, levando em alguns casos à necessidade de ventilação artificial. Este é um diagnóstico clínico, que pode ser sustentado pela integração de diversos resultados, provenientes da análise do líquido cérebro-espinhal, da neuroimagem, dos estudos de condução nervosa e serológicos. A plasmaferese e a imunoglobulina intravenosa (IgIV) são tratamentos que se mostraram eficazes em acelerar a recuperação motora e reduzir a necessidade de ventilação mecânica. Embora a sua eficácia seja comparável, a IgIV é o tratamento de primeira linha e a plasmaferese não é usada numa primeira abordagem devido à necessidade de pessoal especializado e equipamento específico. No entanto, alguns resultados a longo prazo com a monoterapia intravenosa nem sempre são os mais favoráveis e, portanto, estudos combinando as duas intervenções começaram a ser desenvolvidos. Um deles, definindo o método “zipper”, comprovou que a alternância das duas técnicas pode melhorar o resultado, quando comparada a cada intervenção isoladamente. Ainda assim, abordagens com anticorpos monoclonais, como o eculizumab, parecem interessantes, mas apenas em adultos, até ao momento. Neste artigo, o nosso objetivo é rever a evidência existente sobre a abordagem terapêutica imunológica da SGB em crianças.

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Publicado

2024-04-20

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1.
Favinha G, Amaral J, Gomes C, Palavra F. Imunoterapia na Síndrome de Guillain-Barré Pediátrica: Imunoglobulina Endovenosa, Plasmaferese, Ambas ou Algo Mais?. Sinapse [Internet]. 20 de Abril de 2024 [citado 11 de Outubro de 2024];22(2):74-82. Disponível em: https://sinapse.pt/index.php/journal/article/view/67

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