scholarly journals Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

2019 ◽  
Vol 91 (2) ◽  
pp. 113-121 ◽  
Author(s):  
Christine Verboon ◽  
Bianca van den Berg ◽  
David R Cornblath ◽  
Esmee Venema ◽  
Kenneth C Gorson ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Randomised Trial ◽  
Guillain Barre Syndrome ◽  
Original Research ◽  
Disability Score ◽  
Prospective Randomised Trial ◽  
Guillain Barré Syndrome ◽  
Secondary Endpoints ◽  
The One ◽  
Guillain Barré

ObjectiveTo compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.MethodsFrom the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.ResultsOf 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an ‘early’ second IVIg course (1–2 weeks after start of the first IVIg course) and 18 patients a ‘late’ second IVIg course (2–4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.ConclusionsThis observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

scholarly journals Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

The Lancet ◽  
2004 ◽  
Vol 363 (9404) ◽  
pp. 192-196 ◽  
Author(s):  
R van Koningsveld ◽  
PIM Schmitz ◽  
FGA van der Meché ◽  
LH Visser ◽  
J Meulstee ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Standard Treatment ◽  
Randomised Trial ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Relationship of Glycemic Status with Disease Severity in Guillain-Barré Syndrome

2020 ◽  
Vol 6 (2) ◽  
pp. 96-100
Author(s):  
Mohammad Akter Hossain ◽  
Mashfiqul Hasan ◽  
Mohammad Atiqur Rahman ◽  
Murshed Baqui ◽  
Mahmudul Islam ◽  
...  
Keyword(s):  
Disease Severity ◽  
Cross Sectional Study ◽  
Assisted Ventilation ◽  
Guillain Barre Syndrome ◽  
Disability Score ◽  
Cross Sectional ◽  
Sum Score ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Relationship Of

Background: Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuroradiculopathy characterized by flaccid paralysis which may lead to respiratory failure requiring intensive care. Objective: The purpose of the present study was to explore the relationship between the fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and disease severity of GBS patients who are not known to have DM. Methodology: This cross-sectional study included adult GBS patients without having DM [age 35 (22-48) years, median (interqurtile range, IQR); 39 male 22 female] who were admitted to Neurology department, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from July 2018 to June 2019. Demographics, clinical data were noted and FPG, HbA1c were measured. Disease severity were assessed by the GBS disability scale ranging from 0 to 6 with increasing score reflecting increased disability. Results: Patients with more severe GBS (disability score ≥4, unable to walk) had higher frequency of elevated FPG >5.5 mmol/L (61.2%; 30/49) in comparison to those with less severe GBS (disability score ≤3, able to walk; FPG >5.5 mmol/L in 16.7%, 2/12; p=0.006). But distribution of HbA1c category was not different across the groups (disability score ≥4 vs. ≤3: HbA1c <5.7: 40% vs. 58%; 5.7-6.4: 50% vs. 25%; >6.4: 10% vs. 17%; p=0.296). Participants with elevated FPG were elder [elevated vs. normal FPG: 40 (28-54) vs. 25 (19-43) years; median (IQR), p=0.012] and had higher CSF glucose (p=0.002) than those with normal FPG, but there was no difference in respct of gender, MRC sum score, requirement of assisted ventilation, CSF protein, GBS subtypes and duration of hospital stay (p=not significant for all). Conclusions: Patients with severe GBS have higher frequency of elevated FPG but not HbA1c. An acute change in glucose metabolism may occur in GBS which needs further study. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 96-100

scholarly journals Small volume plasma exchange for Guillain-Barré syndrome in resource-limited settings: a phase II safety and feasibility study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022862 ◽  
Author(s):  
Badrul Islam ◽  
Zhahirul Islam ◽  
Shafiqur Rahman ◽  
Hubert P Endtz ◽  
Margreet C Vos ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Plasma Exchange ◽  
Low Income ◽  
Small Volume ◽  
Venous Catheter ◽  
Guillain Barre Syndrome ◽  
Disability Score ◽  
Serious Adverse Events ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

ObjectiveTo assess the safety and feasibility of small volume plasma exchange (SVPE) for patients with Guillain-Barré syndrome (GBS).DesignNon-randomised, single-arm, interventional trial.SettingNational Institute of Neurosciences and Hospital, Dhaka, Bangladesh.ParticipantsTwenty adult (>18 years) patients with GBS presented within 2 weeks of onset of weakness who were unable to walk unaided for more than 10 m.InterventionsSVPE involves blood cell sedimentation in a blood bag and removal of supernatant plasma after blood cells are retransfused. This procedure was repeated three to six times a day, for eight consecutive days. Fresh frozen plasma (FFP) and normal saline were used as replacement fluid.Outcome measuresSerious adverse events (SAEs) were defined as severe sepsis and deep venous thrombosis related to the central venous catheter (CVC) used during SVPE. SVPE was considered safe if less than 5/20 patients experienced an SAE, and feasible if 8 L plasma could be removed within 8 days in at least 15/20 patients.ResultsMedian patient age 33 years (IQR 23–46; range 18–55); 13 (65%) were male. Median Medical Research Council (MRC) sum score was 20 (IQR 0–29; range 0–36); three (15%) patients required mechanical ventilation. One patient developed SAE (severe sepsis, possibly related to CVC). The median plasma volume exchanged was 140 mL/kg (range 110–175) and removal of 8 L plasma was possible in 15 (75%) patients. Patients received a median 1 g/kg IgG via FFP although a substantial proportion of IgG was probably removed again by the SVPE sessions. GBS disability score improved by at least one grade in 14 (70%) patients 4 weeks after SVPE started. No patients died.ConclusionSVPE seems a safe and feasible alternative treatment to standard plasma exchange (PE) or intravenous immunoglobulin (IVIg) for GBS; further studies of clinical efficacy in low-income and middle-income countries are warranted.Trial registration numberNCT02780570.

scholarly journals Serum Folate Correlates with Severity of Guillain-Barré Syndrome and Predicts Disease Progression

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Yang Gao ◽  
Hong-Liang Zhang ◽  
Meiying Xin ◽  
Dong Wang ◽  
Nannan Zheng ◽  
...  
Keyword(s):  
Disease Progression ◽  
Folate Deficiency ◽  
Guillain Barre Syndrome ◽  
Serum Folate ◽  
Folate Level ◽  
Disability Score ◽  
Younger Age ◽  
Sum Score ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

The aim of this study was to determine the associations between serum folate level and the clinical course and severity of Guillain-Barré syndrome (GBS). We retrospectively enrolled 112 pairs of GBS patients and age- and sex-matched healthy controls with measured serum folate levels. On admission, 21 (18.9%) GBS patients had folate deficiency, of which only two were female patients. Patients with normal folate levels had a shorter disease progression than those with folate deficiency (median progression duration: 6 versus 13 days, p < 0.001). Serum folate levels on admission were correlated with progression duration and Medical Research Council (MRC) sum score in the upper limbs at nadir (r = -0.261, p = 0.005; r = -0.208, p = 0.03) but not with the duration of hospital stay or GBS disability score (p > 0.05). Logistic regression analysis revealed that normal folate levels on admission were an independent predictor of faster GBS progression, along with younger age, intact deep sensation, and a lower MRC sum score on admission. These results show that serum folate levels are correlated with the progression duration and severity of GBS. Further studies are required to confirm the potential of folate level as a biomarker for GBS prognosis.

scholarly journals Clinical Course and Predictors of Poor Functional Outcome in Guillain-Barré Syndrome. A Retrospective Study

2020 ◽  
Vol 3 (3) ◽  
pp. 93-98
Author(s):  
Maha Shangab ◽  
Muhammad Al Kaylani
Keyword(s):  
Mechanical Ventilation ◽  
Functional Status ◽  
Functional Outcome ◽  
Nerve Injury ◽  
Guillain Barre Syndrome ◽  
Poor Functional Outcome ◽  
Disability Score ◽  
Tertiary Center ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

<b><i>Introduction:</i></b> Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis. It carries great morbidity due to an overall high rate of poor functional outcome. This study is conducted to study the predictors of poor functional outcome. <b><i>Methods:</i></b> This study a retrospective observational study, which was conducted in Rashid Hospital Tertiary Center in Dubai between 2009 and 2019. Functional status was assessed and followed by the GBS disability score. Functional outcome at 6 months was evaluated for possible predicting factors as well as associated outcomes. <b><i>Results:</i></b> Out of the 82 cases, the mean age at presentation is 37 ± 14.4, with 64 (78%) males. Around one-third of cases (37.8%) had residual deficits at 6 months. Follow-up after 6 months showed that cases with a poor functional outcome are older (<i>p</i> = 0.035) and have presented with a high disability score (<i>p</i> &#x3c; 0.001) and a higher need for mechanical ventilation (<i>p</i> &#x3c; 0.001). Axonal type of nerve injury resulted in poor functional outcome at 6 months compared to the demyelinating type of nerve injury (<i>p</i> = 0.034). Lower rate of improvement at 1 month and poor functional outcome at 6 months resulted in a longer hospital stay (<i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> A poor functional status at presentation, axonal type of nerve injury, and the early requirement for mechanical ventilation are found to predict poor functional improvement after 6 months from diagnosis. These factors must be kept in consideration to facilitate more vigilant management of patient’s associated high morbidity.

Markers for Guillain-Barré syndrome with poor prognosis: a multi-center study

2017 ◽  
Vol 22 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Yuko Yamagishi ◽  
Hidekazu Suzuki ◽  
Masahiro Sonoo ◽  
Satoshi Kuwabara ◽  
Takanori Yokota ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Multi Center Study ◽  
Guillain Barré ◽  
Center Study

scholarly journals Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

2021 ◽  
pp. jnnp-2020-325815
Author(s):  
Christine Verboon ◽  
Thomas Harbo ◽  
David R Cornblath ◽  
Richard A C Hughes ◽  
Pieter A van Doorn ◽  
...  
Keyword(s):  
Supportive Care ◽  
Intravenous Immunoglobulin ◽  
Guillain Barre Syndrome ◽  
Study Entry ◽  
Ivig Treatment ◽  
Disease Course ◽  
Disability Score ◽  
Residual Symptoms ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

ObjectiveTo compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only.MethodsWe selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis.ResultsOf 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms.ConclusionIn patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS.

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