1
|
Irfan S, Ganesan J, Jain KV, A P GA, Ravichandran U. A Rare Presentation of Guillain-Barré Syndrome With Associated Horner Syndrome: A Case Report. Cureus 2024; 16:e57188. [PMID: 38681326 PMCID: PMC11056220 DOI: 10.7759/cureus.57188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy involving the peripheral nervous system. Autonomic dysfunctions are well-known complications of GBS and are major contributors to mortality. Autonomic dysfunctions are classically described during the acute phase of illness. In the literature, Horner syndrome as a manifestation of GBS has been reported in very few cases. Here, we describe a case of GBS with an acute presentation of flaccid paraparesis associated with unilateral Horner syndrome. Detecting the cause of acute flaccid paraparesis with unilateral Horner syndrome poses a diagnostic challenge, making it crucial for clinicians to maintain a heightened awareness for distinguishing between GBS and its variants, as well as other potential mimics.
Collapse
Affiliation(s)
- Shahul Irfan
- Internal Medicine, Government Medical College & Hospital Cuddalore, Chidambaram, IND
| | - Jayashree Ganesan
- Internal Medicine, Government Medical College & Hospital Cuddalore, Chidambaram, IND
| | - Kashish V Jain
- Internal Medicine, Government Medical College & Hospital Cuddalore, Chidambaram, IND
| | - Garvin Ahalya A P
- Internal Medicine, Government Medical College & Hospital Cuddalore, Chidambaram, IND
| | - Umarani Ravichandran
- Internal Medicine, Government Medical College & Hospital Cuddalore, Chidambaram, IND
| |
Collapse
|
2
|
Upadhyay P, Saroa R. A Stitch in Time Defeats the Landry-Guillain-Barré Strohl Syndrome. Cureus 2022; 14:e29047. [PMID: 36237757 PMCID: PMC9553069 DOI: 10.7759/cureus.29047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
The Landry-Guillain-Barré Strohl Syndrome (LGBS) or Guillain-Barré syndrome (GBS) is an acute, frequently severe, potentially fatal, and fulminant polyradiculopathy. It is an autoimmune illness, which usually occurs as a sequela of certain known infections. In this case report, we are discussing the case of a 12-year-old girl who was managed in the ICU for LGBS successfully and recovered promptly. This case highlights the importance of timely administration of intravenous immunoglobulin (IVIG) therapy, which resulted in prompt recovery, reduced duration of ICU stay, and morbidity.
Collapse
|
3
|
Pereira AA, de Oliveira Andrade A, de Andrade Palis A, Cabral AM, Barreto CGL, de Souza DB, de Paula Silva F, Santos FP, Silva GL, Guimarães JFV, de Araújo LAS, Nóbrega LR, Mendes LC, Brandão MR, Milagre ST, de Lima Gonçalves V, de Freitas Morales VH, da Conceição Lima V. Non-pharmacological treatments for COVID-19: current status and consensus. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC7809889 DOI: 10.1007/s42600-020-00116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose COVID-19 is a disease caused by SARS-CoV-2 (coronavirus type 2 of the severe acute respiratory syndrome), isolated in China, in December 2019. The strategy currently used by physicians is to control disease and to treat symptoms, including non-pharmacological treatments, as there is still no specific treatment for COVID-19. Thus, the aim of this article is to carry out a systematic review about non-pharmacological treatments used for COVID-19, addressing current status and consensus found in the literature. Methods Three databases were consulted for evidence referring to the drugs indicated for COVID-19 (Cochrane Central, MEDLINE and Embase). The following terms and combinations were used: ((“2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19”) OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*)) AND ((“lung injury”) OR (“ventilation use”) OR (“respiratory injuries” OR prone)) AND (treatment)) NOT Drugs NOT medicines NOT antivirals. Results A total of 28 articles were selected. These articles adopted one or more treatment methods for patients with severe cases of COVID-19, i.e., oxygen therapy, prone position, inhaled nitric oxide, intravenous infusion, passive immunotherapy, mesenchymal stem cells (MSC). Conclusion There is still no specific treatment approved for patients with COVID-19. The available evidence is not able yet to indicate the benefits or harms of non-pharmacological treatments, but some studies show that some treatments can play an important role in relation to COVID-19. The current consensus among researchers is that several studies using a randomized clinical trial should be carried out to provide evidence of safety and efficacy of the proposed treatments.
Collapse
Affiliation(s)
- Adriano Alves Pereira
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Angélica de Andrade Palis
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Ariana Moura Cabral
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Cassiana Gabriela Lima Barreto
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Daniel Baldoino de Souza
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Fernanda de Paula Silva
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Fernando Pasquini Santos
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Gabriella Lelis Silva
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - José Flávio Viana Guimarães
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Laureane Almeida Santiago de Araújo
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Lígia Reis Nóbrega
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Luanne Cardoso Mendes
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Mariana Ribeiro Brandão
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Selma Terezinha Milagre
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Verônica de Lima Gonçalves
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Viviane da Conceição Lima
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| |
Collapse
|
4
|
Dalakas MC, Spaeth PJ. The importance of FcRn in neuro-immunotherapies: From IgG catabolism, FCGRT gene polymorphisms, IVIg dosing and efficiency to specific FcRn inhibitors. Ther Adv Neurol Disord 2021; 14:1756286421997381. [PMID: 33717213 PMCID: PMC7917847 DOI: 10.1177/1756286421997381] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
The neonatal Fc receptor (FcRn) binds endogenous IgG and protects it from lysosomal degradation by transporting it back to the cell surface to re-enter the circulation, extending the serum IgG life span. FcRn plays a role in the function of IVIg because the supraphysiological IgG levels derived from IVIg administrations saturate the FcRn allowing the endogenous IgG to be degraded, instead of being recycled, resulting in high levels of infused IgG ensuring IVIg efficiency. New data in myasthenia gravis patients suggest that the that the Variable Number of Tandem 3/2 (VNTR3/2) polymorphisms in FCGRT, the gene that encodes FcRn, may affect the duration of infused IgG in the circulation and IVIg effectiveness. This review addresses these implications in the context of whether the FCGRT genotype, by affecting the half-life of IVIg, may also play a role in up to 30% of patients with autoimmune neurological diseases, such as Guillain–Barré syndrome, CIDP or Multifocal Motor Neuropathy, who did not respond to IVIg in controlled trials. The concern is of practical significance because in such patient subsets super-high IVIg doses may be needed to achieve high IgG levels and ensure efficacy. Whether FCGRT polymorphisms affect the efficacy of other therapeutic monoclonal antibodies by influencing their distribution clearance and pharmacokinetics, explaining their variable effectiveness, is also addressed. Finally, the very promising effect of monoclonal antibodies that inhibit FcRn, such as efgartigimod, rozanolixizumab and nipocalimab, in treating antibody-mediated neurological diseases is discussed along with their efficacy in the IgG4 subclass of pathogenic antibodies and their role in the blood–brain barrier endothelium, that abundantly expresses FcRn.
Collapse
Affiliation(s)
- Marinos C Dalakas
- Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA
| | - Peter J Spaeth
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Aabdi M, Mellagui Y, Bensaid A, Bkiyar H, Housni B. Guillain-Barré Syndrome During the Postpartum Period. Cureus 2020; 12:e12021. [PMID: 33457125 PMCID: PMC7797439 DOI: 10.7759/cureus.12021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy that manifests with ascending symmetrical and progressive weakness or paralysis with the absence of reflexes. The incidence of this syndrome in pregnancy and postpartum periods is similar to the general population; however, few published clinical cases have been described. Here, we report the case of a 26-year-old patient who developed GBS with respiratory distress two weeks after her baby's delivery that required long-term mechanical ventilation. The patient's clinical conditions were significantly improved after the use of immunoglobulins and rehabilitation, and she was discharged. Physicians should be aware of the possibility of developing GBS during pregnancy and postpartum periods.
Collapse
Affiliation(s)
- Mohammed Aabdi
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Yassine Mellagui
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Amine Bensaid
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Houssam Bkiyar
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Brahim Housni
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| |
Collapse
|
6
|
Odales J, Guzman Valle J, Martínez-Cortés F, Manoutcharian K. Immunogenic properties of immunoglobulin superfamily members within complex biological networks. Cell Immunol 2020; 358:104235. [PMID: 33137645 PMCID: PMC7548077 DOI: 10.1016/j.cellimm.2020.104235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 12/01/2022]
Abstract
Antibody-based therapies induce CDR-specific T and B cell responses. Idiotype-anti-idiotype network alters immune system memory compartment. Antigenized antibodies are efficient vaccine immunogen.
Antibodies, T cell receptors and major histocompatibility complex molecules are members of the immunoglobulin superfamily and have pivotal roles in the immune system. The fine interrelation between them regulates several immune functions. Here, we describe lesser-known functions ascribed to these molecules in generating and maintaining immune response. Particularly, we outline the contribution of antibody- and T cell receptor-derived complementarity-determining region neoantigens, antigenized antibodies, as well as major histocompatibility complex class I molecules-derived epitopes to the induction of protective/therapeutic immune responses against pathogens and cancer. We discuss findings of our own and other studies describing protective mechanisms, based on immunogenic properties of immunoglobulin superfamily members, and evaluate the perspectives of application of this class of immunogens in molecular vaccines design.
Collapse
Affiliation(s)
- Josué Odales
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), AP 70228, Ciudad Universitaria, México, DF 04510, Mexico
| | - Jesus Guzman Valle
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), AP 70228, Ciudad Universitaria, México, DF 04510, Mexico
| | - Fernando Martínez-Cortés
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), AP 70228, Ciudad Universitaria, México, DF 04510, Mexico
| | - Karen Manoutcharian
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), AP 70228, Ciudad Universitaria, México, DF 04510, Mexico.
| |
Collapse
|
7
|
Algahtani H, Shirah B, Alrefaei K, Albassam M, Abdelghaffar N. Are Repeated Cycles of Intravenous Immunoglobulin Justified in Patients With Poorly Responsive Guillain-Barré Syndrome? Neurohospitalist 2020; 10:224-228. [PMID: 32549948 DOI: 10.1177/1941874419893570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a life-threatening form of inflammatory polyneuropathy. Immunotherapy with intravenous immunoglobulin (IVIG) has been used successfully in the treatment of GBS. In this case report, we present a severe axonal form of GBS that showed improvement after 3 cycles of IVIG. Repeated cycles of IVIG may be an option for treating severe forms of GBS not responding to the first course of such treatment. The recent work suggests that patients who are severely affected and have severe gadolinium enhancement on the magnetic resonance imaging of the spine should be considered for retreatment with IVIG. Although the cost of management was high, the outcome was excellent, which is definitely considered a reasonable approach. This case report is an urgent call for performing large multicenter trials on the use of repeated cycles of IVIG in the management of severe cases of GBS.
Collapse
Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Khalid Alrefaei
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Albassam
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | |
Collapse
|
8
|
Arora A, Shere A, Patel K, Gunawardhana N, LiFuentes E. A Rare Case of Autoimmune Demyelinating Polyneuropathy and Hydrocephalus Secondary to Pembrolizumab. J Investig Med High Impact Case Rep 2020; 8:2324709620916358. [PMID: 32321302 PMCID: PMC7180301 DOI: 10.1177/2324709620916358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pembrolizumab is a humanized monoclonal antibody that targets the programmed cell
death 1 protein (PD-1) receptor and blocks the inhibitory checkpoint interaction
between PD-1 and its ligands. This interaction leads to the upregulation of
effector T-cells and downregulating regulatory T-cell production. Although this
mechanism is essential for the management of cancer, it may lead to decreased
self-tolerance with an autoimmune reaction toward healthy functioning tissue.
One of the less commonly reported and less understood immune-related adverse
events includes neuromuscular complications. We present a rare case of
autoimmune demyelinating polyneuropathy and hydrocephalus secondary to
pembrolizumab use for cutaneous squamous cell carcinoma of the cheek.
Collapse
Affiliation(s)
| | - Amar Shere
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | | |
Collapse
|
9
|
Hughes RAC. Guillain-Barré syndrome: looking back… and forward. J Neurol Neurosurg Psychiatry 2020; 91:111-112. [PMID: 31924731 DOI: 10.1136/jnnp-2019-322361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/08/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Richard A C Hughes
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| |
Collapse
|
10
|
Liu H, Ma Y. Hepatitis E virus-associated Guillain-Barre syndrome: Revision of the literature. Brain Behav 2020; 10:e01496. [PMID: 31828968 PMCID: PMC6955827 DOI: 10.1002/brb3.1496] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The association between preceding infection of hepatitis E virus (HEV) and Guillain-Barre syndrome (GBS) has been found for more than a decade, while hepatitis E virus-associated Guillain-Barre syndrome (HEV-associated GBS) still remains poorly understood. Initially discovered in 2000, the association between GBS and HEV has been focused by neurologists increasingly. Five percent of patients with GBS had preceding acute HEV infection in the Netherlands and higher rate was found in Bangladesh (11%) where HEV is endemic. METHOD An extensive review of relevant literature was undertaken. RESULTS Hepatitis E virus infection may induce GBS via direct viral damage according to recent research findings. On the other hand, the presence of antiganglioside GM1 or GM2 antibodies in serum of some HEV-associated GBS patients indicates that HEV infection may trigger GBS by activating autoimmune response to destroy myelin or axon mistakenly. Management of HEV-associated GBS has no obvious difference from GBS. It mainly consists of supportive therapy and immunotherapy. Intravenous immunoglobulin (IVIG) or plasma exchange (PLEX) was used in most reported cases, which is the main strategy for clinical treatment of HEV-associated GBS. Whether antiviral therapy could be additional strategy other than the routine therapy to shorten the length of disease course is one of the most urgent problems and requires further study. CONCLUSIONS An overview of possible pathogenesis will gain a first insight into why HEV, traditionally recognized as only hepatotropic, can induce many neurological disorders represented by GBS. Moreover, understanding of the underlying mechanisms may contribute to development of a novel therapeutic strategy. This review also summarizes management and clinical characteristics of HEV-associated GBS, aiming to achieve early recognition and good recovery.
Collapse
Affiliation(s)
- Hang Liu
- Department of NeurologyShengjing HospitalChina Medical UniversityShenyangChina
| | - Ying Ma
- Department of NeurologyShengjing HospitalChina Medical UniversityShenyangChina
| |
Collapse
|
11
|
Thakolwiboon S, Karukote A, Sohn G. Acute motor-sensory axonal neuropathy associated with systemic lupus erythematosus. Proc (Bayl Univ Med Cent) 2019; 32:610-613. [PMID: 31656439 DOI: 10.1080/08998280.2019.1647715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and is generally treated by immunosuppressive agents. Acute motor-sensory axonal neuropathy (AMSAN) is a variant of Guillain-Barré syndrome. The standard therapies are intravenous immunoglobulin or plasmapheresis. An association between AMSAN and SLE is rarely reported. Herein, we describe a case of a 72-year-old man who presented with rapidly progressive paraparesis, dysesthesia, and joint pain with morning stiffness. Initially, he was diagnosed with AMSAN. Intravenous immunoglobulin was given without significant improvement. Subsequent studies indicated the diagnosis of SLE. Therefore, the patient was treated with intravenous methylprednisolone, cyclophosphamide, and then plasmapheresis. At 3 months, he improved from bedridden to wheelchair-bound. Our case demonstrates AMSAN as a rare initial manifestation that can lead to significant disability.
Collapse
Affiliation(s)
| | - Amputch Karukote
- Department of Neurology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Gyeongmo Sohn
- Department of Neurology, Texas Tech University Health Sciences CenterLubbockTexas
| |
Collapse
|
12
|
Neuromuscular Disorders in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
Patwala K, Crump N, De Cruz P. Guillain-Barré syndrome in association with antitumour necrosis factor therapy: a case of mistaken identity. BMJ Case Rep 2017; 2017:bcr-2017-219481. [PMID: 28679512 PMCID: PMC5534643 DOI: 10.1136/bcr-2017-219481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease characterised by evolving ascending limb weakness, sensory loss and areflexia. Two-thirds of GBS cases are associated with preceding infection. However, GBS has also been described in association with antitumour necrosis factor (TNF) therapies including infliximab and adalimumab for chronic inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. We present the case of a patient who developed GBS while undergoing treatment with adalimumab in combination with azathioprine for severe fistulising Crohn's disease, and review the literature on neurological adverse events that occur in association with anti-TNF therapy. We also propose an approach to the optimal management of patients who develop debilitating neurological sequelae in the setting of anti-TNF therapy.
Collapse
Affiliation(s)
- Kurvi Patwala
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
| | - Nicholas Crump
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
14
|
Maddur MS, Stephen-Victor E, Das M, Prakhar P, Sharma VK, Singh V, Rabin M, Trinath J, Balaji KN, Bolgert F, Vallat JM, Magy L, Kaveri SV, Bayry J. Regulatory T cell frequency, but not plasma IL-33 levels, represents potential immunological biomarker to predict clinical response to intravenous immunoglobulin therapy. J Neuroinflammation 2017; 14:58. [PMID: 28320438 PMCID: PMC5360043 DOI: 10.1186/s12974-017-0818-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/18/2017] [Indexed: 02/08/2023] Open
Abstract
Background Intravenous immunoglobulin (IVIG) is a polyspecific pooled immunoglobulin G preparation and one of the commonly used therapeutics for autoimmune diseases including those of neurological origin. A recent report in murine model proposed that IVIG expands regulatory T (Treg) cells via induction of interleukin 33 (IL-33). However, translational insight on these observations is lacking. Methods Ten newly diagnosed Guillain-Barré syndrome (GBS) patients were treated with IVIG at the rate of 0.4 g/kg for three to five consecutive days. Clinical evaluation for muscular weakness was performed by Medical Research Council (MRC) and modified Rankin scoring (MRS) system. Heparinized blood samples were collected before and 1, 2, and 4–5 weeks post-IVIG therapy. Peripheral blood mononuclear cells were stained for surface CD4 and intracellular Foxp3, IFN-γ, and tumor necrosis factor alpha (TNF-α) and were analyzed by flow cytometry. IL-33 and prostaglandin E2 in the plasma were measured by ELISA. Results The fold changes in plasma IL-33 at week 1 showed no correlation with the MRC and MRS scores at weeks 1, 2, and ≥4 post-IVIG therapy. Clinical recovery following IVIG therapy appears to be associated with Treg cell response. Contrary to murine study, there was no association between the fold changes in IL-33 at week 1 and Treg cell frequency at weeks 1, 2, and ≥4 post-IVIG therapy. Treg cell-mediated clinical response to IVIG therapy in GBS patients was associated with reciprocal regulation of effector T cells-expressing TNF-α. Conclusion Treg cell expansion by IVIG in patients with autoimmune diseases lack correlation with IL-33. Treg cell frequency, but not plasma IL-33 levels, represents potential immunological biomarker to predict clinical response to IVIG therapy.
Collapse
Affiliation(s)
- Mohan S Maddur
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France.,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France.,Université Paris Descartes, UMR S 1138, Paris, 75006, France.,Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329, USA
| | - Emmanuel Stephen-Victor
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France.,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France
| | - Mrinmoy Das
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France.,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France
| | - Praveen Prakhar
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, 560012, India
| | - Varun K Sharma
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France.,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France.,Université Paris Descartes, UMR S 1138, Paris, 75006, France
| | - Vikas Singh
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, 560012, India
| | - Magalie Rabin
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France
| | - Jamma Trinath
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, 560012, India
| | - Kithiganahalli N Balaji
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, 560012, India
| | - Francis Bolgert
- Réanimation Neurologique, Neurologie 1, Hôpital de la Pitié-Salpêtrière, Paris, 75651, France
| | - Jean-Michel Vallat
- Centre de Référence 'Neuropathies Périphériques Rares' et Service de Neurologie, Hôpital Universitaire Limoges, Limoges, 87042, France
| | - Laurent Magy
- Centre de Référence 'Neuropathies Périphériques Rares' et Service de Neurologie, Hôpital Universitaire Limoges, Limoges, 87042, France
| | - Srini V Kaveri
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France. .,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France. .,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France. .,Université Paris Descartes, UMR S 1138, Paris, 75006, France.
| | - Jagadeesh Bayry
- Institut National de la Santé et de la Recherche Médicale, Unité 1138, Paris, 75006, France. .,Centre de Recherche des Cordeliers, Equipe- Immunopathologie et immuno-intervention thérapeutique, Paris, 75006, France. .,Sorbonne Universités, UPMC Univ Paris 06, UMR S 1138, Paris, 75006, France. .,Université Paris Descartes, UMR S 1138, Paris, 75006, France.
| |
Collapse
|
15
|
Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms. Clin Rev Allergy Immunol 2017; 51:303-314. [PMID: 26142065 DOI: 10.1007/s12016-015-8499-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy. In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned. Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.
Collapse
|
16
|
Pritchard J, Hughes RAC, Hadden RDM, Brassington R. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2016; 11:CD008630. [PMID: 27846348 PMCID: PMC6464710 DOI: 10.1002/14651858.cd008630.pub4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Plasma exchange and intravenous immunoglobulin, but not corticosteroids, are beneficial in Guillain-Barré syndrome (GBS). The efficacy of other pharmacological agents is unknown. This review was first published in 2011 and updated in 2013 and 2016. OBJECTIVES To assess the effects of pharmacological agents other than plasma exchange, intravenous immunoglobulin and corticosteroids for GBS. SEARCH METHODS On 18 January 2016, we searched the Cochrane Neuromuscular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for treatments for GBS. We also searched clinical trials registries. SELECTION CRITERIA We included all randomised controlled trials (RCTs) or quasi-RCTs of acute GBS (within four weeks from onset) of all types and degrees of severity, and in individuals of all ages. We discarded trials that investigated only corticosteroids, intravenous immunoglobulin or plasma exchange. We included other pharmacological treatments or combinations of treatments compared with no treatment, placebo or another treatment. We also identified a number of non-randomised studies during the search, the results of which we considered in the Discussion. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. MAIN RESULTS We identified no new trials during this update of the review. In previous versions of this review we identified only very low quality evidence for four different interventions published in four studies. Each study had a high risk of bias in at least one respect. One RCT with 19 participants comparing interferon beta-1a and placebo showed no clinically important difference in any outcome between groups. Another with 10 participants comparing brain-derived neurotrophic factor and placebo showed no clinically important difference in any outcome between groups. A third with 37 participants comparing cerebrospinal fluid filtration and plasma exchange also showed no clinically important difference in any outcome between groups. In a fourth with 43 participants, the risk ratio for an improvement by one or more disability grade after eight weeks was greater with the Chinese herbal medicine tripterygium polyglycoside than with corticosteroids (risk ratio 1.47; 95% confidence interval 1.02 to 2.11); other outcomes in this trial showed no difference. Serious adverse events were uncommon with each of these treatments and in the control groups. AUTHORS' CONCLUSIONS The quality of the evidence was very low. Three small RCTs, comparing interferon beta-1a or brain-derived neurotrophic factor with placebo, and cerebrospinal fluid filtration with plasma exchange, showed no significant benefit or harm for any of the interventions. A fourth small trial showed that the Chinese herbal medicine, tripterygium polyglycoside, hastened recovery in people with GBS to a greater extent than corticosteroids, but this result needs confirmation. We were unable to draw any useful conclusions from the few observational studies we identified.
Collapse
Affiliation(s)
- Jane Pritchard
- Charing Cross HospitalNeuromuscular Unit 3 NorthFulham Palace RoadLondonUKW6 8RF
| | - Richard AC Hughes
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesPO Box 114Queen SquareLondonUKWC1N 3BG
| | - Robert DM Hadden
- King's College HospitalDepartment of NeurologyDenmark HillLondonUKSE5 9RS
| | - Ruth Brassington
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesPO Box 114Queen SquareLondonUKWC1N 3BG
| |
Collapse
|
17
|
Grünewald B, Bennett JL, Toyka KV, Sommer C, Geis C. Efficacy of Polyvalent Human Immunoglobulins in an Animal Model of Neuromyelitis Optica Evoked by Intrathecal Anti-Aquaporin 4 Antibodies. Int J Mol Sci 2016; 17:E1407. [PMID: 27571069 PMCID: PMC5037687 DOI: 10.3390/ijms17091407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
Abstract
Neuromyelitis Optica Spectrum Disorders (NMOSD) are associated with autoantibodies (ABs) targeting the astrocytic aquaporin-4 water channels (AQP4-ABs). These ABs have a direct pathogenic role by initiating a variety of immunological and inflammatory processes in the course of disease. In a recently-established animal model, chronic intrathecal passive-transfer of immunoglobulin G from NMOSD patients (NMO-IgG), or of recombinant human AQP4-ABs (rAB-AQP4), provided evidence for complementary and immune-cell independent effects of AQP4-ABs. Utilizing this animal model, we here tested the effects of systemically and intrathecally applied pooled human immunoglobulins (IVIg) using a preventive and a therapeutic paradigm. In NMO-IgG animals, prophylactic application of systemic IVIg led to a reduced median disease score of 2.4 on a 0-10 scale, in comparison to 4.1 with sham treatment. Therapeutic IVIg, applied systemically after the 10th intrathecal NMO-IgG injection, significantly reduced the disease score by 0.8. Intrathecal IVIg application induced a beneficial effect in animals with NMO-IgG (median score IVIg 1.6 vs. sham 3.7) or with rAB-AQP4 (median score IVIg 2.0 vs. sham 3.7). We here provide evidence that treatment with IVIg ameliorates disease symptoms in this passive-transfer model, in analogy to former studies investigating passive-transfer animal models of other antibody-mediated disorders.
Collapse
Affiliation(s)
- Benedikt Grünewald
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
- Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado Denver, Aurora, CO 80045, USA.
| | - Klaus V Toyka
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Christian Geis
- Hans-Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
- Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| |
Collapse
|
18
|
Sarada PP, Sundararajan K. The devil is in the detail: Acute Guillain-Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit. Indian J Crit Care Med 2016; 20:238-41. [PMID: 27303139 PMCID: PMC4906336 DOI: 10.4103/0972-5229.180045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit.
Collapse
|
19
|
Barahona Afonso AF, João CMP. The Production Processes and Biological Effects of Intravenous Immunoglobulin. Biomolecules 2016; 6:15. [PMID: 27005671 PMCID: PMC4808809 DOI: 10.3390/biom6010015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
Immunoglobulin is a highly diverse autologous molecule able to influence immunity in different physiological and diseased situations. Its effect may be visible both in terms of development and function of B and T lymphocytes. Polyclonal immunoglobulin may be used as therapy in many diseases in different circumstances such as primary and secondary hypogammaglobulinemia, recurrent infections, polyneuropathies, cancer, after allogeneic transplantation in the presence of infections and/or GVHD. However, recent studies have broadened the possible uses of polyclonal immunoglobulin showing that it can stimulate certain sub-populations of T cells with effects on T cell proliferation, survival and function in situations of lymphopenia. These results present a novel and considerable impact of intravenous immunoglobulin (IVIg) treatment in situations of severe lymphopenia, a situation that can occur in cancer patients after chemo and radiotherapy treatments. In this review paper the established and experimental role of polyclonal immunoglobulin will be presented and discussed as well as the manufacturing processes involved in their production.
Collapse
Affiliation(s)
- Ana Filipa Barahona Afonso
- Department of Chemistry, Universidade de Évora, Colégio Luís António Verney, Rua Romão Ramalho 59, 7000-671 Évora, Portugal.
| | - Cristina Maria Pires João
- Hematology Department, Champalimaud Center for the Unknown, Av. Brasília, 1400-038 Lisboa, Portugal.
| |
Collapse
|
20
|
Abstract
Immunotherapy has been investigated in a small subset of peripheral neuropathies, including an acute one, Guillain-Barré syndrome, and 3 chronic forms: chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and neuropathy associated with IgM anti-myelin-associated glycoprotein. Several experimental studies and clinical data are strongly suggestive of an immune-mediated pathogenesis. Either cell-mediated mechanisms or antibody responses to Schwann cell, compact myelin, or nodal antigens are considered to act together in an aberrant immune response to cause damage to peripheral nerves. Immunomodulatory treatments used in these neuropathies aim to act at various steps of this pathogenic process. However, there are many phenotypic variants and, consequently, there is a significant difference in the response to immunotherapy between these neuropathies, as well as a need to improve our knowledge and long-term management of chronic forms.
Collapse
Affiliation(s)
- Jean-Marc Léger
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France.
| | - Raquel Guimarães-Costa
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France
| | - Cristina Muntean
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France
| |
Collapse
|
21
|
Zhang E, Li M, Zhao J, Dong Y, Yang X, Huang J. Traditional Chinese medicine Yisui Tongjing relieved neural severity in experimental autoimmune neuritis rat model. Neuropsychiatr Dis Treat 2016; 12:2481-2487. [PMID: 27729792 PMCID: PMC5047740 DOI: 10.2147/ndt.s110813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To study the effect of Yisui Tongjing (YSTJ) prescription on motor nerve conduction velocity (MNCV) and microstructure of the sciatic nerve in experimental autoimmune neuritis (EAN) rats, the Guillain-Barré syndrome classic animal models. MATERIALS AND METHODS In this study, we established an EAN model in Lewis rats by immunization. We evaluated the potential clinical application of a traditional Chinese medicine YSTJ by intragastric administration and compared its effect with immunoglobulin. The sciatic MNCV was measured by electrophysiology experiment. Hematoxylin-eosin staining and transmission electron microscope analysis were used to determine the pathologically morphological changes before and after YSTJ application. RESULTS We found that application of YSTJ could significantly alleviate the clinical signs in EAN rats. The treatment also increased MNCV in the sciatic nerve compared to that in the untreated nerve. Demyelination in the sciatic nerve in EAN rats was significantly ameliorated, and newly generated myelinated nerve fibers were observed with treatment of high dose of YSTJ. CONCLUSION This study showed that the traditional Chinese medicine YSTJ was likely to serve as a therapeutic medicine in autoimmune neuropathies, providing an effective and economic means to the treatment of Guillain-Barré syndrome.
Collapse
Affiliation(s)
- Erli Zhang
- Department of Traditional Chinese Medicine, The First Bethune Hospital of Jilin University
| | - Mingquan Li
- Department of Encephalopathy, The First Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, People's Republic of China
| | - Jianjun Zhao
- Department of Encephalopathy, The First Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, People's Republic of China
| | - Yuxiang Dong
- Department of Traditional Chinese Medicine, The First Bethune Hospital of Jilin University
| | - Xueqin Yang
- Department of Traditional Chinese Medicine, The First Bethune Hospital of Jilin University
| | - Jingbo Huang
- Department of Traditional Chinese Medicine, The First Bethune Hospital of Jilin University
| |
Collapse
|
22
|
Abstract
Guillain-Barré syndrome (GBS) is an acute and usually monophasic, neurological, demyelinating disease. Although most patients have good outcomes without sequelae after conventional plasma exchange and intravenous immunoglobulin therapy, 20% of patients continue to have severe disease and 5% die of their disease. Therefore, there is an obvious need for more acceptable and efficacious therapies. Experimental autoimmune neuritis (EAN) is the classical animal model for GBS. As there is no specific drug for GBS, several drugs targeting the humoral and cellular components of the immune response have been used to treat EAN in the endeavour to find new treatment alternatives for GBS. This review focused on some new strategies for GBS, which have been reported but have not yet been widely used, and on the main drugs which have been investigated in EAN.
Collapse
|
23
|
Fokkink WJR, Selman MHC, Wuhrer M, Jacobs BC. Immunoglobulin G Fc N-glycosylation in Guillain-Barré syndrome treated with intravenous immunoglobulin. Clin Exp Immunol 2015; 178 Suppl 1:105-7. [PMID: 25546781 DOI: 10.1111/cei.12530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- W-J R Fokkink
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | | |
Collapse
|
24
|
Gilardin L, Bayry J, Kaveri SV. Intravenous immunoglobulin as clinical immune-modulating therapy. CMAJ 2015; 187:257-264. [PMID: 25667260 DOI: 10.1503/cmaj.130375] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Laurent Gilardin
- Unité 872, Institut national de la santé et de la recherche médicale, and Équipe 16: Immunopathologie et immuno-intervention thérapeutique, Centre de recherche des Cordeliers, Université Pierre et Marie Curie and Université Paris Descartes, Paris, France
| | - Jagadeesh Bayry
- Unité 872, Institut national de la santé et de la recherche médicale, and Équipe 16: Immunopathologie et immuno-intervention thérapeutique, Centre de recherche des Cordeliers, Université Pierre et Marie Curie and Université Paris Descartes, Paris, France
| | - Srini V Kaveri
- Unité 872, Institut national de la santé et de la recherche médicale, and Équipe 16: Immunopathologie et immuno-intervention thérapeutique, Centre de recherche des Cordeliers, Université Pierre et Marie Curie and Université Paris Descartes, Paris, France
| |
Collapse
|
25
|
Nagelkerke SQ, Kuijpers TW. Immunomodulation by IVIg and the Role of Fc-Gamma Receptors: Classic Mechanisms of Action after all? Front Immunol 2015; 5:674. [PMID: 25653650 PMCID: PMC4301001 DOI: 10.3389/fimmu.2014.00674] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/15/2014] [Indexed: 11/13/2022] Open
Abstract
Intravenous IgG (IVIg) contains polyclonal immunoglobulin G (IgG) from thousands of donors. It is administered at a low dose at regular intervals as antibody replacement therapy and at a higher dose as immunomodulatory treatment in various auto-immune or auto-inflammatory diseases. The working mechanism of immunomodulation is not well understood. Many different explanations have been given. During the last decade, we have focused on classical antibody binding via the Fc-domain of the IgG molecules to the common IgG receptors, i.e. the Fcγ receptors (FcγRs). Variation in the genes encoding human FcγRs determines function as well as expression among immune cells. As described here, NK cells and myeloid cells, including macrophages, can express different FcγR variants, depending on the individual's genotype, copy number variation (CNV), and promoter polymorphisms. B-cells seem to only express the single inhibitory receptor. Although these inhibitory FcγRIIb receptors are also expressed by monocytes, macrophages, and only rarely by NK cells or neutrophils, their presence is unlikely to explain the immunomodulatory capacity of IVIg, nor does the sialylation of IgG. Direct IVIg effects at the level of the activating FcγRs, including the more recently described FcγRIIc, deserve renewed attention to describe IVIg-related immunomodulation.
Collapse
Affiliation(s)
- Sietse Q Nagelkerke
- Department of Blood Cell Research, Sanquin, University of Amsterdam , Amsterdam , Netherlands
| | - Taco W Kuijpers
- Department of Blood Cell Research, Sanquin, University of Amsterdam , Amsterdam , Netherlands ; Department of Pediatric Hematology, Immunology and Infectious Disease, Emma Children's Hospital at the Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| |
Collapse
|
26
|
Chea S, Cheng YB, Chokephaibulkit K, Chotpitayasunondh T, Rogier van Doorn H, Hafy Z, Kawichai S, Liu CC, Nam NT, Ooi MH, Wolbers M, Zeng M. Workshop on use of intravenous immunoglobulin in hand, foot and mouth disease in Southeast Asia. Emerg Infect Dis 2015; 21:e140992. [PMID: 25531166 PMCID: PMC4285270 DOI: 10.3201/eid2101.140992] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The South East Asia Infectious Disease Clinical Research Network convened subject matter experts at a workshop to make consensus recommendations for study design of a clinical trial for use of intravenous immunoglobulin (IVIg) in severe hand, foot and mouth disease (HFMD). HFMD is a highly contagious emerging infection among children in the region, a small proportion of whom develop neurologic and cardiopulmonary complications with high case-fatality rates. The use of IVIg for treatment of severe disease is widespread and a part of local, national, and international guidelines, but no clinical evidence warrants the use of this drug, which is expensive and has potentially serious side effects. During a 2-day workshop in March 2014, a group of HFMD experts reviewed the current evidence related to use of IVIg in HFMD and discussed potential study design, feasibility, inclusion and exclusion criteria, sample size, primary and secondary endpoints, and subsidiary studies for a randomized, placebo-controlled trial.
Collapse
|
27
|
Kerr J, Quinti I, Eibl M, Chapel H, Späth PJ, Sewell WAC, Salama A, van Schaik IN, Kuijpers TW, Peter HH. Is dosing of therapeutic immunoglobulins optimal? A review of a three-decade long debate in europe. Front Immunol 2014; 5:629. [PMID: 25566244 PMCID: PMC4263903 DOI: 10.3389/fimmu.2014.00629] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/25/2014] [Indexed: 12/13/2022] Open
Abstract
The consumption of immunoglobulins (Ig) is increasing due to better recognition of antibody deficiencies, an aging population, and new indications. This review aims to examine the various dosing regimens and research developments in the established and in some of the relevant off-label indications in Europe. The background to the current regulatory settings in Europe is provided as a backdrop for the latest developments in primary and secondary immunodeficiencies and in immunomodulatory indications. In these heterogeneous areas, clinical trials encompassing different routes of administration, varying intervals, and infusion rates are paving the way toward more individualized therapy regimens. In primary antibody deficiencies, adjustments in dosing and intervals will depend on the clinical presentation, effective IgG trough levels and IgG metabolism. Ideally, individual pharmacokinetic profiles in conjunction with the clinical phenotype could lead to highly tailored treatment. In practice, incremental dosage increases are necessary to titrate the optimal dose for more severely ill patients. Higher intravenous doses in these patients also have beneficial immunomodulatory effects beyond mere IgG replacement. Better understanding of the pharmacokinetics of Ig therapy is leading to a move away from simplistic "per kg" dosing. Defective antibody production is common in many secondary immunodeficiencies irrespective of whether the causative factor was lymphoid malignancies (established indications), certain autoimmune disorders, immunosuppressive agents, or biologics. This antibody failure, as shown by test immunization, may be amenable to treatment with replacement Ig therapy. In certain immunomodulatory settings [e.g., idiopathic thrombocytopenic purpura (ITP)], selection of patients for Ig therapy may be enhanced by relevant biomarkers in order to exclude non-responders and thus obtain higher response rates. In this review, the developments in dosing of therapeutic immunoglobulins have been limited to high and some medium priority indications such as ITP, Kawasaki' disease, Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, myasthenia gravis, multifocal motor neuropathy, fetal alloimmune thrombocytopenia, fetal hemolytic anemia, and dermatological diseases.
Collapse
Affiliation(s)
- Jacqueline Kerr
- Section Poly- and Monoclonal Antibodies, Paul Ehrlich Institut, Langen, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Helen Chapel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter J. Späth
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | | | - Abdulgabar Salama
- Zentrum für Transfusionsmedizin u. Zelltherapie, Charité, Berlin, Germany
| | - Ivo N. van Schaik
- Department of Neurology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious disease, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Hans-Hartmut Peter
- Centrum für chronische Immunodeficienz (CCI), University Medical Centre, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
28
|
Nguyen TP, Biliciler S, Wahed A, Sheikh K. Occurrence of hemolytic anemia in patients with GBS treated with high-dose IVIg. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2014; 1:e50. [PMID: 25520957 PMCID: PMC4268039 DOI: 10.1212/nxi.0000000000000050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/24/2014] [Indexed: 11/15/2022]
Abstract
Objective: We describe an underrecognized side effect of high-dose IV immunoglobulin (IVIg), hemolytic anemia. Background: There are no established guidelines on treating patients with Guillain-Barré syndrome (GBS) who relapse or do not improve after a standard course of treatment (IVIg or plasma exchange). Some centers will opt for a second course of the initial treatment. There is an ongoing trial of a second course of IVIg in patients with severe GBS. Methods: We retrospectively reviewed 4 patients with severe GBS who received high-dose IVIg. One patient inadvertently received a high dose of IVIg for Miller Fisher syndrome. All patients received a total of at least 2 courses of the standard dose of IVIg (total >4 g/kg). We review their clinical course and side effects. Results: All patients with non-O blood types developed clinically significant hemolytic anemia requiring blood transfusion. Conclusion: Hemolytic anemia may limit doses of IVIg for treatment of severe GBS in patients with non-O blood types.
Collapse
Affiliation(s)
- Thy P Nguyen
- Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX
| | - Suur Biliciler
- Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX
| | - Amer Wahed
- Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX
| | - Kazim Sheikh
- Departments of Neurology (T.P.N., S.B., K.S.) and Pathology (A.W.), University of Texas Health Science Center at Houston, TX
| |
Collapse
|
29
|
Zülfikar B, Koç B. Use of intravenous immunoglobulin in pediatric practice. TURK PEDIATRI ARSIVI 2014; 49:282-8. [PMID: 26078679 PMCID: PMC4462316 DOI: 10.5152/tpa.2014.2212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/24/2014] [Indexed: 12/13/2022]
Abstract
In recent years, human-driven intravenous immunoglobulins (IVIG) administered intravenously have been widely used in treatment of many diseases. Intravenous immunoglobulin is obtained from human-driven plasma pools as in other plasma-driven products and IVIG preperations contain structurally and functionally intact immunoglobulin. Intravenous immunoglobulin was approved by FDA (Food and Drug Administration) in USA in 1981 for the first time and was started to be primarily used in patients with immune deficiency with hypogammaglobulinemia. The effects of intravenous immunoglobulin include complex mechanisms, but it exerts its essential action by eliminating the non-specific Fc receptors found in the mononuclear phagocytic system or by inhibiting binding of immune complexes to Fc receptors in the cells. Their areas of usage include conditions where their anti-inflammatory and immunomudulator effects are utilized in addition to replacement of deficient immunoglobulin. Although the definite indications are limited, it has been shown that it is useful in many diseases in clinical practice. Its side effects include fever, sweating, nausea, tachycardia, eczematous reactions, aseptic meningitis, renal failure and hematological-thromboembolic events. In this article, use of IVIG, its mechanisms of action, indications and side effects were discussed.
Collapse
Affiliation(s)
- Bülent Zülfikar
- Division of Pediatric Hematology-Oncology, İstanbul University, Cerrahpaşa Medical Faculty and Oncology Institute, İstanbul, Turkey
| | - Başak Koç
- Division of Pediatric Hematology-Oncology, İstanbul University, Cerrahpaşa Medical Faculty and Oncology Institute, İstanbul, Turkey
| |
Collapse
|
30
|
Berger M, McCallus DE, Lin CSY. Rapid and reversible responses to IVIG in autoimmune neuromuscular diseases suggest mechanisms of action involving competition with functionally important autoantibodies. J Peripher Nerv Syst 2014; 18:275-96. [PMID: 24200120 PMCID: PMC4285221 DOI: 10.1111/jns5.12048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Intravenous immunoglobulin (IVIG) is widely used in autoimmune neuromuscular diseases whose pathogenesis is undefined. Many different effects of IVIG have been demonstrated in vitro, but few studies actually identify the mechanism(s) most important in vivo. Doses and treatment intervals are generally chosen empirically. Recent studies in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy show that some effects of IVIG are readily reversible and highly dependent on the serum IgG level. This suggests that in some autoantibody-mediated neuromuscular diseases, IVIG directly competes with autoantibodies that reversibly interfere with nerve conduction. Mechanisms of action of IVIG which most likely involve direct competition with autoantibodies include: neutralization of autoantibodies by anti-idiotypes, inhibition of complement deposition, and increasing catabolism of pathologic antibodies by saturating FcRn. Indirect immunomodulatory effects are not as likely to involve competition and may not have the same reversibility and dose-dependency. Pharmacodynamic analyses should be informative regarding most relevant mechanism(s) of action of IVIG as well as the role of autoantibodies in the immunopathogenesis of each disease. Better understanding of the role of autoantibodies and of the target(s) of IVIG could lead to more efficient use of this therapy and better patient outcomes.
Collapse
Affiliation(s)
- Melvin Berger
- Departments of Pediatrics and Pathology, Case Western Reserve University, Cleveland, OH, USA; Immunology Research and Development, CSL Behring, LLC, King of Prussia, PA, USA
| | | | | |
Collapse
|
31
|
Abstract
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents.
Collapse
Affiliation(s)
- Kate T. Brizzi
- Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Lyons
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
32
|
Role of cytokines and Toll-like receptors in the immunopathogenesis of Guillain-Barré syndrome. Mediators Inflamm 2014; 2014:758639. [PMID: 25614713 PMCID: PMC4189947 DOI: 10.1155/2014/758639] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/13/2014] [Indexed: 11/17/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system, mostly triggered by an aberrant immune response to an infectious pathogen. Although several infections have been implicated in the pathogenesis of GBS, not all such infected individuals develop this disease. Moreover, infection with a single agent might also lead to different subtypes of GBS emphasizing the role of host factors in the development of GBS. The host factors regulate a broad range of inflammatory processes that are involved in the pathogenesis of autoimmune diseases including GBS. Evidences suggest that systemically and locally released cytokines and their involvement in immune-mediated demyelination and axonal damage of peripheral nerves are important in the pathogenesis of GBS. Toll-like receptors (TLRs) link innate and adaptive immunity through transcription of several proinflammatory cytokines. TLR genes may increase susceptibility to microbial infections; an attenuated immune response towards antigen and downregulation of cytokines occurs due to mutation in the gene. Herein, we discuss the crucial role of host factors such as cytokines and TLRs that activate the immune response and are involved in the pathogenesis of the disease.
Collapse
|
33
|
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin (IVIg) is beneficial in other autoimmune diseases. This is an update of a review first published in 2001 and previously updated in 2003, 2005, 2007, 2010 and 2012. Other Cochrane systematic reviews have shown that plasma exchange (PE) significantly hastens recovery in GBS compared with supportive treatment alone, and that corticosteroids alone are ineffective. OBJECTIVES We had the following four objectives.1. To examine the efficacy of intravenous immunoglobulin (IVIg) in hastening recovery and reducing the long-term morbidity from Guillain-Barré syndrome (GBS).2. To determine the most efficacious dose of IVIg in hastening recovery and reducing the long-term morbidity from GBS.3. To compare the efficacy of IVIg and plasma exchange (PE) or immunoabsorption in hastening recovery and reducing the long-term morbidity from GBS.4. To compare the efficacy of IVIg added to PE with PE alone in hastening recovery and reducing the long-term morbidity from GBS. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (2 December 2013), CENTRAL (2013, Issue 12 in The Cochrane Library), MEDLINE (January 1966 to November 2013) and EMBASE (January 1980 to November 2013). We checked the bibliographies in reports of the randomised trials and contacted the authors and other experts in the field to identify additional published or unpublished data. SELECTION CRITERIA Randomised and quasi-randomised trials of IVIg compared with no treatment, placebo treatment, PE, or other immunomodulatory treatments in children and adults with GBS of all degrees of severity. We also included trials in which IVIg was added to another treatment. DATA COLLECTION AND ANALYSIS Two authors independently selected papers, extracted data and assessed quality. We collected data about adverse events from the included trials. MAIN RESULTS Twelve trials were found to be eligible for inclusion in this review. Seven trials with a variable risk of bias compared IVIg with PE in 623 severely affected participants. In five trials with 536 participants for whom the outcome was available, the mean difference (MD) of change in a seven-grade disability scale after four weeks was not significantly different between the two treatments: MD of 0.02 of a grade more improvement in the intravenous immunoglobulin than the plasma exchange group; 95% confidence interval (CI) 0.25 to -0.20. There were also no statistically significant differences in the other measures considered. Three studies including a total of 75 children suggested that IVIg significantly hastens recovery compared with supportive care. The primary outcome for this review, available for only one trial with 21 mildly affected children, showed significantly more improvement in disability grade after four weeks with IVIg than supportive treatment alone, MD 1.42, 95% CI 2.57 to 0.27.In one trial involving 249 participants comparing PE followed by IVIg with PE alone, the mean grade improvement was 0.2 (95% CI -0.14 to 0.54) more in the combined treatment group than in the PE alone group; not clinically significantly different, but not excluding the possibility of significant extra benefit. Another trial with 34 participants comparing immunoabsorption followed by IVIg with immunoabsorption alone did not reveal significant extra benefit from the combined treatment.Adverse events were not significantly more frequent with either treatment, but IVIg is significantly much more likely to be completed than PE.Small trials in children showed a trend towards more improvement with high-dose compared with low-dose IVIg, and no significant difference when the standard dose was given over two days rather than five days. AUTHORS' CONCLUSIONS A previous Cochrane review has shown that PE hastens recovery compared with supportive treatment alone. There are no adequate comparisons of IVIg with placebo in adults, but this review provides moderate quality evidence that, in severe disease, IVIg started within two weeks from onset hastens recovery as much as PE. Adverse events were not significantly more frequent with either treatment but IVIg is significantly much more likely to be completed than PE. Also, according to moderate quality evidence, giving IVIg after PE did not confer significant extra benefit. In children, according to low quality evidence, IVIg probably hastens recovery compared with supportive care alone. More research is needed in mild disease and in patients whose treatment starts more than two weeks after onset. Dose-ranging studies are also needed and one is in progress.
Collapse
Affiliation(s)
- Richard AC Hughes
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesPO Box 114Queen SquareLondonUKWC1N 3BG
| | - Anthony V Swan
- National Hospital for Neurology and NeurosurgeryCochrane Neuromuscular Disease Group, MRC Centre for Neuromuscular DiseasesPO Box 114LondonUKWC1N 3BG
| | - Pieter A van Doorn
- Erasmus University Medical CenterDepartment of NeurologyPO Box 2040RotterdamNetherlands3000 CA
| | | |
Collapse
|
34
|
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014; 10:469-82. [DOI: 10.1038/nrneurol.2014.121] [Citation(s) in RCA: 556] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
35
|
Charra B, Hachimi A, Benslama A, Motaouakkil S. Intravenous immunoglobulin vs plasma exchange in treatment of mechanically ventilated adults with Guillain-Barré syndrome. Pan Afr Med J 2014; 18:35. [PMID: 25368724 PMCID: PMC4215378 DOI: 10.11604/pamj.2014.18.35.2911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 05/03/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of the study is to compare efficacy of IvIg versus PE in treatment of mechanically ventilation adults with GBS in intensive care unit. Methods It is a prospective, non randomized study, realized in a medical ICU from 2006 to 2010. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 4 PE during 10-14 days). We collected demographic characteristics, clinical and therapeutic aspects and outcome. Statistical analysis used: The quantitative variables are expressed on mean ± standard derivation and compared by Student test. The statistic analysis has been based on SPSS for windows. P < 0.05 is considered as significant. Results Forty-one patients (21 in group 1 and 20 in group 2) were enrolled. The mean age was 37.4 ± 9.2 years, with a masculine predominance (75.4%). Electromyogram in all patients found acute inflammatory demyelinating polyradiculoneuropathy in 80.5% of patients. The mean length of hospitalization was 45.3 ± 9.2 days. The length of hospitalization of the IvIg group is less long than PE group (p = 0.03). The weaning of the MV was more precocious in IvIg group than PE group (p = 0.01). Also, the beginning of motility recuperation was precocious at IvIg group than PE group (p = 0.04). Conclusion Our work reveals a meaningful difference for the MV weaning and precocious recovery in IvIg group compared to PE group.
Collapse
Affiliation(s)
- Boubaker Charra
- Medical Intensive Care Unit, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdelhamid Hachimi
- Medical-Surgical Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacology, Cadi Ayyad University, Marrakech, Morocco
| | - Abdellatif Benslama
- Medical Intensive Care Unit, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Said Motaouakkil
- Medical Intensive Care Unit, Ibn Rochd University Hospital, Casablanca, Morocco
| |
Collapse
|
36
|
Ruzhansky K, Brannagan TH. Intravenous immunoglobulin for treatment of neuromuscular disease. Neurol Clin Pract 2013; 3:440-445. [PMID: 29473612 DOI: 10.1212/cpj.0b013e3182a78ecf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravenous immunoglobulin (IVIg) has been widely used in the treatment of autoimmune neuromuscular diseases. Compared to other treatment modalities, such as corticosteroids and chemotherapy for autoimmune disorders, IVIg has relatively few side effects and favorable therapeutic outcomes in certain neuromuscular diseases. There is Class I evidence for IVIg as an initial treatment for patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy. It is as effective as plasma exchange in GBS and CIDP. In myasthenia gravis, IVIg is used for myasthenic crisis and exacerbations, though it is also helpful as maintenance therapy, particularly in patients with a suboptimal response or contraindications to prednisone or other immunosuppressive agents. IVIg has been demonstrated to be beneficial in placebo-controlled, double-blind, randomized studies in dermatomyositis and Lambert-Eaton syndrome. IVIg has also been beneficial in select patients with polymyositis and other autoimmune peripheral neuropathies. Clinical trials in amyotrophic lateral sclerosis, inclusion body myositis, and anti-myelin-associated glycoprotein neuropathy have been negative.
Collapse
Affiliation(s)
- Katherine Ruzhansky
- Peripheral Neuropathy Center, Neurological Institute, Columbia University, College of Physicians and Surgeons, New York, NY
| | - Thomas H Brannagan
- Peripheral Neuropathy Center, Neurological Institute, Columbia University, College of Physicians and Surgeons, New York, NY
| |
Collapse
|
37
|
Cortese I, Cornblath DR. Therapeutic plasma exchange in neurology: 2012. J Clin Apher 2013; 28:16-9. [PMID: 23420591 DOI: 10.1002/jca.21266] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/15/2013] [Indexed: 12/18/2022]
Abstract
In treating neuroimmunological diseases, neurologists have a number of different drugs to choose from ranging from corticosteroids to IVIg to more specific cell based therapies, the latter most frequently from the world of oncology. In some diseases, therapeutic plasma exchange, a procedure rather than a drug, is used. The most obvious advantage of therapeutic plasma exchange is the usually rapid onset of action presumably due to removal of pathogenic auto-antibodies. In some diseases, a single course of therapeutic plasma exchange is used while in others prolonged treatment with therapeutic plasma exchange is used. This article will review the use of therapeutic plasma exchange in neurology and will draw heavily upon recent consensus statements from the American Society for Apheresis and the American Academy of Neurology and by Cochrane reviews.
Collapse
Affiliation(s)
- Irene Cortese
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | | |
Collapse
|
38
|
Navani V, Webster D, Williams SK, Agranoff D. Guillain-Barre syndrome as a paraneoplastic manifestation of disseminated squamous cell carcinoma. BMJ Case Rep 2013; 2013:bcr-2013-009700. [PMID: 23729714 DOI: 10.1136/bcr-2013-009700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We describe a 65-year-old woman who developed ascending, symmetrical paraesthesia and weakness. This was on a background of metastatic disseminated squamous cell carcinoma, with a likely recurrent mandibular primary. Serum testing for antiganglioside antibodies was strongly positive. Despite a 5-day course of intravenous immunoglobulin, the patient passed away on day 34 of admission. This is the first case, to our knowledge, of Guillain-Barré syndrome in association with squamous cell carcimoma.
Collapse
Affiliation(s)
- Vishal Navani
- Department of Infectious Diseases, Brighton and Sussex University Hospitals, Brighton, UK.
| | | | | | | |
Collapse
|