Imunoterapia na Síndrome de Guillain-Barré Pediátrica: Imunoglobulina Endovenosa, Plasmaferese, Ambas ou Algo Mais?
DOI:
https://doi.org/10.46531/sinapse/AR/220002/2022Palavras-chave:
Criança, Imunoglobulina Intravenosa, Imunoterapia, Plasmaferese, Síndrome de Guillain-Barré/ tratamento, Troca PlasmáticaResumo
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.Downloads
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Direitos de Autor (c) 2024 Gonçalo Favinha, Joana Amaral, Catarina Gomes, Filipe Palavra
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