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Titus J, Sarmiento B, Crouse R. Management of Severe Pain in a Case of Sensory Guillain-Barre Syndrome. Cureus 2024; 16:e64432. [PMID: 39130815 PMCID: PMC11317124 DOI: 10.7759/cureus.64432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Guillain-Barre syndrome (GBS) is an acute post-infectious polyradiculoneuropathy characterized by autoantibodies targeting host antigens, resulting in nerve fiber demyelination and axonal degeneration. While symmetric ascending weakness is typical, neuropathic pain is a common yet variable manifestation. We present a case of a 52-year-old man with progressive bilateral leg weakness and severe neuropathic pain following a flu-like illness. Despite conventional analgesics, his pain persisted, necessitating a unique pain management approach. The patient's examination revealed hyporeflexia and sensory deficits consistent with GBS. Diagnostic workup, including lumbar puncture, showed albuminocytologic dissociation. Plasma exchange therapy was initiated, but severe nocturnal neuropathic pain persisted, exacerbating during treatment. Conventional pain medications were ineffective, prompting a multimodal approach. Combining hydromorphone and lorazepam provided significant pain relief, enabling completion of plasmapheresis sessions. This regimen, supplemented with gabapentin, proved effective in managing both GBS-associated and treatment-induced pain. This case underscores the debilitating nature of GBS-related pain and the importance of tailored pain management strategies. While conventional agents may fail, a multimodal approach, including opioids and adjunctive medications, can offer relief, facilitating essential treatments like plasmapheresis. Careful monitoring is imperative to mitigate risks associated with potent analgesics. Our experience contributes to the armamentarium for managing GBS-related pain, emphasizing individualized care to improve patient outcomes.
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Affiliation(s)
- Joane Titus
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Bernard Sarmiento
- Neurology, University of Central Florida College of Medicine, Orlando, USA
| | - Roger Crouse
- Internal Medicine, University of Central Florida Hospital Corporation of America (HCA) Healthcare Graduate Medical Education (GME), Orlando, USA
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2
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Li X, Zhang C. Guillain-Barré syndrome after surgery: a literature review. Front Neurol 2024; 15:1368706. [PMID: 38638310 PMCID: PMC11024248 DOI: 10.3389/fneur.2024.1368706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/26/2024] [Indexed: 04/20/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare postoperative complication that is sometimes characterized by serious motor weakness and prolonged weaning from mechanical ventilation. Although the exact nature of the relationship between GBS and the surgical procedure is still unclear, there is a clear increased incidence of GBS in post-surgical patients compared to non-surgical patients. GBS after surgery is unique in several ways. The course of post-surgical GBS unfolds more rapidly than in other situations where GBS develops, the condition is often more severe, and respiratory muscles are more commonly involved. Prompt diagnosis and appropriate treatment are essential, and the condition can worsen if treated inappropriately. Postoperative sedation, intubation, and restraint use make the diagnosis of GBS difficult, as the onset of symptoms of weakness or numbness in those contexts are not obvious. GBS is often misdiagnosed, being attributed to other postoperative complications, and subsequently mishandled. The lack of relevant information further obscures the clinical picture. We sought to better understand post-surgical GBS by performing an analysis of the relevant literature, focusing on clearly documenting the clinical characteristics, diagnosis, and management of GBS that emerges following surgery. We underscore the importance of physicians being aware of the possibility of GBS after major surgery and of performing a variety of laboratory clinical investigations early on in suspected cases.
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Affiliation(s)
| | - Chao Zhang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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3
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Singh A, Jain E, Sharma V, Sinha A, Khaliq W. Guillain-Barré Syndrome Presenting as Painful Weakness and Edema of the Legs: A Case Report. Cureus 2023; 15:e40641. [PMID: 37476105 PMCID: PMC10355341 DOI: 10.7759/cureus.40641] [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: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune inflammatory polyneuropathy, which can be challenging to diagnose due to variability in the initial presenting features. Pain, flaccid paresis, motor sensory disturbance, hyporeflexia, and autonomic dysfunction are the typical manifestations, although atypical features, such as ataxia, neck stiffness, dysphagia, ophthalmoplegia, bulbar palsy, and isolated upper limb weakness, may be seen. It may also progress to fatal respiratory depression. As such, timely diagnosis and treatment are essential. We present the case of a 41-year-old man who presented with a four-day history of acute-onset bilateral lower extremity swelling, decreased motor strength, diffuse muscle pain, hyporeflexia, and absent vibratory sensation. After admission, symptoms worsened, and the patient developed new-onset swallowing difficulty and urinary retention. Neurological examination findings of hyporeflexia and flaccid paralysis, along with normal thyroid function, and the absence of cord compression on spinal MRI pointed toward the diagnosis of GBS. Nerve conduction studies (NCS) and concentric electromyography (EMG) confirmed the diagnosis. The patient was treated with intravenous immune globulin (IVIG) and eventually discharged to a rehabilitation facility after a 12-day hospital stay. Later, the patient developed contractures and chronic pain consistent with post-GBS syndrome, for which we referred him for pain management and physical therapy. A rapidly progressive weakness with autonomic dysfunction should prompt suspicion of GBS and should be treated with intravenous immunoglobulins or plasma exchange without further delay.
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Affiliation(s)
- Amteshwar Singh
- Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Evani Jain
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Venus Sharma
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amitasha Sinha
- Hospital Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Waseem Khaliq
- Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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4
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Duvuru R, Raju S, Nawaz F. A Rare Case of Miller Fisher Syndrome in a 45-Year-Old Female. Cureus 2023; 15:e36387. [PMID: 37090296 PMCID: PMC10113916 DOI: 10.7759/cureus.36387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Miller Fisher syndrome (MFS) is an uncommon form of Guillain-Barré syndrome (GBS), a neurological condition that is acquired, degenerative, demyelinating, and frequently characterized by gradual, symmetrical ascending paralysis. Ophthalmoplegia, ataxia, and areflexia are common symptoms that follow a bacterial or viral infection. Here, we want to draw attention to a rare case of MFS in a 45-year-old Indian female who had dysphagia, dysphasia, ataxia, and dyskinesia while moving around. Unusually, she had no past medical history of Campylobacter jejuni infection, recent vaccinations, upper respiratory tract infections, or any sexually transmitted diseases. Since this disorder has excellent prognosis, early diagnosis and effective treatment are crucial to minimizing unnecessary medical intervention and psychological suffering.
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Affiliation(s)
- Ruthwik Duvuru
- Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Shivani Raju
- Neurology, The Oxford Medical College, Hospital & Research Centre, Bangalore, IND
| | - Faisal Nawaz
- Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
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5
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Pota V, Coppolino F, Barbarisi A, Passavanti MB, Aurilio C, Sansone P, Pace MC. Pain in Intensive Care: A Narrative Review. Pain Ther 2022; 11:359-367. [PMID: 35220551 PMCID: PMC9098741 DOI: 10.1007/s40122-022-00366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Francesco Coppolino
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfonso Barbarisi
- Department of Translational Medical Science, Telematic University Pegaso, Naples, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Caterina Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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Apetse K, Dongmo Tajeuna J, Kumako V, Waklatsi K, Kombate D, Assogba K, Balogou A. [Guillain-Barré syndrome in hospitals in Togo]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsibulletin.2021.124. [PMID: 35686169 PMCID: PMC9128467 DOI: 10.48327/mtsibulletin.2021.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
Introduction In sub-Saharan Africa characterized by limited resources especially in health facilities and a relatively higher frequency of infectious diseases, studies on Guillain-Barré syndrome (GBS) are rare. Objectives The objectives of this work are to describe the characteristics of GBS in Togo through a cohort of patients followed in the neurology unit of the Campus University Hospital of Lomé. Methodology The study took place from May 2015 to July 2019. Patients with GBS of levels 1 to 3 of the Brighton criteria for diagnostic certainty were included consecutively and assessed at admission, at 6 months and at 1 year with the GBS disability score and the MRC sum score. Qualitative and quantitative variables were expressed, respectively, in frequency and median (interquartile range). Results Out of 7012 hospitalized patients, 28 (0.39%) including 20 women (71%) with a median age of 40 (27-53) years, presented GBS. The clinical presentation mainly consisted of bilateral sensory-motor disorders predominantly in the lower limbs associated with facial diplegia and preceded by an infectious event. On admission, 39% of patients (n=11) were able to walk (GBS score 0 to 3) and the median MRC sum score was 28 (12-38). Cytoalbuminologic dissociation was present in 654% of patients (13 of 20 patients who underwent lumbar puncture). The demyelinating and axonal subtypes each accounted for 47% (9 of 19 patients who underwent an electroneuromyography examination). Immunoglobulins and intravenous corticosteroid therapy were administered in 18% (n=5) and 50% (n=14) of patients, respectively. Lethality rate during hospitalization was 11% (n=3). The median MRC sum score at 6 and 12 month-outcome were 40 (38-49) and 51 (46-58), respectively. After one year of evolution, case fatality rate was 18% (n=5), and 78% of survivors (n=14) could walk without assistance, of which 17% (n=3) were asymptomatic. Conclusion In Togo, GBS, with a low hospital prevalence, remains a serious condition due to its high morbidity and lethality related to non-optimal treatment and delayed management.
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Affiliation(s)
- K. Apetse
- Faculté des sciences de la santé, Université de Lomé, Lomé, Togo,Service de neurologie, CHU CAMPUS de Lomé, Lomé, Togo,*
| | | | - V.K. Kumako
- Faculté des sciences de la santé, Université de Kara, Kara, Togo,Service de neurologie, CHU Kara, Kara, Togo
| | - K.P. Waklatsi
- Service de neurologie, CHU CAMPUS de Lomé, Lomé, Togo
| | - D. Kombate
- Faculté des sciences de la santé, Université de Lomé, Lomé, Togo,Service de neurologie, CHU CAMPUS de Lomé, Lomé, Togo
| | - K. Assogba
- Faculté des sciences de la santé, Université de Lomé, Lomé, Togo,Service de neurologie, CHU CAMPUS de Lomé, Lomé, Togo
| | - A.K. Balogou
- Faculté des sciences de la santé, Université de Lomé, Lomé, Togo,Service de neurologie, CHU CAMPUS de Lomé, Lomé, Togo
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Erstad BL. Attempts to Limit Opioid Prescribing in Critically Ill Patients: Not So Easy, Not So Fast. Ann Pharmacother 2019; 53:716-725. [PMID: 30638027 DOI: 10.1177/1060028018824724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To discuss why opioids have been considered the long-standing first-line therapy for treating acute, severe nociceptive pain in critically ill patients and discuss considerations for limiting opioid overuse in the intensive care unit setting. DATA SOURCES Articles were identified through searches of PubMed and EMBASE from database inception until December 2018. Additional references were located through a review of the bibliographies of articles and clinical practice guidelines. STUDY SELECTION AND DATA EXTRACTION Original research articles excluding case reports were included if they concerned nonopioid agents for pain management in critically ill patients. The focus was on studies not included in the most recent pain management guidelines. DATA SYNTHESIS Ten studies were retrieved. Nonopioid therapies or opioid-sparing therapies have been touted as possible alternatives for critically ill patients, but they have particular adverse effects concerns in critically ill patients, often lack parenteral dosage forms, and frequently require dose adjustment or avoidance in patients with renal or hepatic dysfunction. Relevance to Patient Care and Clinical Practice: There is a well-recognized opioid epidemic that has been the subject of much discussion. Attempts to control the epidemic have focused on limiting opioid prescribing and using nonopioid alternatives, but there are special considerations when treating severe pain in critically ill patients that often preclude nonopioid analgesics. CONCLUSIONS There continues to be an unmet need for medications that are as effective as opioids for severe nociceptive pain in critically ill patients but without the adverse effect and abuse concerns. Until such medications are available, clinicians need to optimize prescribing of opioid and nonopioid analgesics.
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Guillain-Barre Syndrome. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Meregalli C, Marjanovic I, Scali C, Monza L, Spinoni N, Galliani C, Brivio R, Chiorazzi A, Ballarini E, Rodriguez-Menendez V, Carozzi VA, Alberti P, Fumagalli G, Pozzi E, Canta A, Quartu M, Briani C, Oggioni N, Marmiroli P, Cavaletti G. High-dose intravenous immunoglobulins reduce nerve macrophage infiltration and the severity of bortezomib-induced peripheral neurotoxicity in rats. J Neuroinflammation 2018; 15:232. [PMID: 30131066 PMCID: PMC6103882 DOI: 10.1186/s12974-018-1270-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background Chemotherapy-induced peripheral neurotoxicity (CIPN) is a severe adverse effect in patients receiving antitumor agents, and no effective treatment is available. Although the mechanisms responsible for the development of CIPN are poorly understood, recent findings make neuroinflammation an attractive target to be investigated, particularly when neuropathic pain is a prominent feature such as after bortezomib administration. The aim of our study was to evaluate the effect of intravenous immunoglobulins (IVIg) delivery in chronic CIPN. The related neuro-immune aspects were investigated in a well-characterized rat model of bortezomib-induced peripheral neurotoxicity (BIPN). Methods After determination of a suitable schedule based on a preliminary pharmacokinetic pilot study, female Wistar rats were treated with IVIg 1 g/kg every 2 weeks. IVIg treatment was started at the beginning of bortezomib administration (“preventive” schedule), or once BIPN was already ensued after 4 weeks of treatment (“therapeutic” schedule). Neurophysiological and behavioral studies were performed to assess the extent of painful peripheral neurotoxicity induced by bortezomib, and these functional assessments were completed by pathologic examination of peripheral nerves and intraepidermal nerve fiber quantification (IENF). The role of the innate immune response in BIPN was investigated by immunochemistry characterization of macrophage infiltration in peripheral nerves. Results Both schedules of IVIg administration were able to significantly reduce bortezomib-induced heat and mechanical allodynia. Although these changes were not evidenced at the neurophysiological examination of peripheral nerves, they behavioral effects were paralleled in the animals treated with the preventive schedule by reduced axonopathy in peripheral nerves and significant protection from loss of IENF. Moreover, IVIg administration was very effective in reducing infiltration in peripheral nerves of macrophages with the M1, pro-inflammatory phenotype. Conclusion Our results suggest a prominent role of neuroinflammation in BIPN and that IVIg might be considered as a possible safe and effective therapeutic option preventing M1 macrophage infiltration. However, since neuropathic pain is frequent also in other CIPN types, it also indicates the need for further investigation in other forms of CIPN.
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Affiliation(s)
- Cristina Meregalli
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.
| | - Ivan Marjanovic
- Kedrion S.p.A, Loc. Ai Conti, Castelvecchio Pascoli, Lucca, Italy
| | - Carla Scali
- Kedrion S.p.A, Loc. Ai Conti, Castelvecchio Pascoli, Lucca, Italy
| | - Laura Monza
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.,PhD program in Translational and Molecular Medicine (Dimet), University of Milano-Bicocca, Monza, Italy
| | - Nadia Spinoni
- Clinical Chemistry Laboratory, S. Gerardo Hospital, Monza, Italy
| | | | - Rinaldo Brivio
- Clinical Chemistry Laboratory, S. Gerardo Hospital, Monza, Italy
| | - Alessia Chiorazzi
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Elisa Ballarini
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Virginia Rodriguez-Menendez
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Valentina Alda Carozzi
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.,Young Against Pain group, Parma, Italy
| | - Paola Alberti
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.,PhD program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Giulia Fumagalli
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.,PhD program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Eleonora Pozzi
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy.,PhD program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Annalisa Canta
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Marina Quartu
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Chiara Briani
- Department of Neuroscience, Neurology Unit, University of Padova, Padova, Italy
| | - Norberto Oggioni
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Paola Marmiroli
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, MB, Italy
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Abstract
Neuromuscular diseases are syndromic disorders that affect nerve, muscle, and/or neuromuscular junction. Knowledge about the management of these diseases is required for anesthesiologists, because these may frequently be encountered in the intensive care unit, operating room, and other settings. The challenges and advances in management for some of the neuromuscular diseases most commonly encountered in the operating room and neurointensive care unit are reviewed.
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Affiliation(s)
- Veronica Crespo
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA
| | - Michael L Luke James
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA; Department of Neurology, Duke University, Erwin Road, Durham, NC 27710, USA.
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11
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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12
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Abstract
Guillain-Barré syndrome is the most common and most severe acute paralytic neuropathy, with about 100,000 people developing the disorder every year worldwide. Under the umbrella term of Guillain-Barré syndrome are several recognisable variants with distinct clinical and pathological features. The severe, generalised manifestation of Guillain-Barré syndrome with respiratory failure affects 20-30% of cases. Treatment with intravenous immunoglobulin or plasma exchange is the optimal management approach, alongside supportive care. Understanding of the infectious triggers and immunological and pathological mechanisms has advanced substantially in the past 10 years, and is guiding clinical trials investigating new treatments. Investigators of large, worldwide, collaborative studies of the spectrum of Guillain-Barré syndrome are accruing data for clinical and biological databases to inform the development of outcome predictors and disease biomarkers. Such studies are transforming the clinical and scientific landscape of acute autoimmune neuropathies.
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Affiliation(s)
- Hugh J Willison
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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13
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Martini R, Willison H. Neuroinflammation in the peripheral nerve: Cause, modulator, or bystander in peripheral neuropathies? Glia 2016; 64:475-86. [PMID: 26250643 PMCID: PMC4832258 DOI: 10.1002/glia.22899] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/15/2022]
Abstract
The role of innate and adaptive inflammation as a primary driver or modifier of neuropathy in premorbidly normal nerves, and as a critical player in amplifying neuropathies of other known causes (e.g., genetic, metabolic) is incompletely understood and under-researched, despite unmet clinical need. Also, cellular and humoral components of the adaptive and innate immune system are substantial disease modifying agents in the context of neuropathies and, at least in some neuropathies, there is an identified tight interrelationship between both compartments of the immune system. Additionally, the quadruple relationship between Schwann cell, axon, macrophage, and endoneurial fibroblast, with their diverse membrane bound and soluble signalling systems, forms a distinct focus for investigation in nerve diseases with inflammation secondary to Schwann cell mutations and possibly others. Identification of key immunological effector pathways that amplify neuropathic features and associated clinical symptomatology including pain should lead to realistic and timely possibilities for translatable therapeutic interventions using existing immunomodulators, alongside the development of novel therapeutic targets.
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Affiliation(s)
- Rudolf Martini
- Department of NeurologyDevelopmental Neurobiology, University Hospital WürzburgWürzburgD‐97080Germany
| | - Hugh Willison
- Institute of Infection, Immunity and Inflammation College of Medical Veterinary and Life Sciences, Glasgow Biomedical Research Centre, University of GlasgowGlasgowG12 8TA
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