From the Guidelines
Acute Motor Axonal Neuropathy (AMAN) should be treated with either intravenous immunoglobulin (IVIG) at a dose of 0.4 g/kg body weight daily for 5 days or plasma exchange (PLEX) with 5 exchanges at 200–250 ml/kg, as these treatments have been proven to be equally effective in managing Guillain-Barré Syndrome (GBS) 1. The choice between IVIG and PLEX should be based on availability, ease of administration, and patient-specific factors, with IVIG being generally preferred due to its ease of administration and wider availability 1. Some key points to consider in the management of AMAN include:
- Prompt initiation of treatment, ideally within 2 weeks of symptom onset, to improve outcomes 1
- Supportive care, including respiratory monitoring, DVT prophylaxis, pain management, and early rehabilitation, to address the potential complications of AMAN 1
- Consideration of the patient's overall clinical context, including the presence of any underlying infections or other medical conditions, when making treatment decisions 1 It is also important to note that other treatments, such as corticosteroids, have not been proven to be effective in managing GBS and may even have negative effects 1. In resource-limited settings, small-volume plasma exchange (SVPE) may be a viable alternative to conventional PLEX, although further studies are needed to establish its efficacy 1. Overall, the management of AMAN requires a multidisciplinary approach, with a focus on prompt and effective treatment, as well as supportive care to address the potential complications of this condition.
From the Research
AMAN Rapidly Progressive Guillain Barre
- AMAN (Acute Motor Axonal Neuropathy) is a subtype of Guillain-Barré syndrome (GBS) characterized by rapid progression and axonal involvement 2
- Therapeutic Plasma Exchange (TPE) has been shown to be beneficial in the management of severe IVIG refractory GBS with axonal involvement, including AMAN 2
- A study of six pediatric cases of AMAN found that 5 out of 6 patients were eventually weaned from mechanical ventilation and discharged from the hospital after receiving TPE 2
Treatment Options
- Intravenous immunoglobulin (IVIG) and plasma exchange (PE) are commonly used treatments for GBS, including AMAN 3, 4, 5
- A systematic review and meta-analysis found that IVIG and PE have similar curative effects in treating GBS patients with severe symptoms 5
- However, another study found that PE after initial IVIG treatment did not improve short-term outcomes, but increased cost and duration of hospitalization 6