Audit of care of acute inflammatory polyradiculoneuropathy in Italy

A multicentre prospective investigation of the main treatment regimens for the Guillain-Barré syndrome (GBS) was started in Italy to assess the quality of the care delivered for GBS in clinical practice. Between 14 April 1988 and 31 December 1993, 250 patients (157 males and 93 females aged 3 to 86 years) were recruited in 14 centres. The commonest treatments were plasma exchange (PE) (62 per cent), steroids (ST) (37 per cent) and immunoglobulins (IG) (19 per cent). Eighteen per cent of cases received ST and PE. These data contrast in part with reports on the treatment of GBS published between 1976 and 1993, which showed PE as an effective treatment, IG as a promising but still experimental drug, and ST as a failing therapeutic approach. The variables which seemed to affect the treatment choices most were centre, year of diagnosis, and disease severity. According to this survey, the treatment of GBS in Italy tends only partly to reflect the indications and recommendations in the main scientific reports. This not only indicates a suboptimal impact of the best available knowledge on the treatment of GBS, but also documents the need for more definite guidelines and further research through clinical trials.